Related Articles - Annals Singapore

Letter to the Editor

Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial

Balakrishnan Ashokka, Shree Venkatesan, Theng Wai Foong, Chang Chuan Melvin Lee, Lian Kah Ti

Dear Editor, Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of...

Letter to the Editor

Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

Tiing Leong Ang, Yaw Chong Goh, Khoon Lin Ling

Dear Editor, The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an...

Letter to the Editor

Sedation in gastrointestinal endoscopy in Singapore

Wah Tze Tan

Dear Editor, I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use...

Letter to the Editor

Non-anaesthesiologists administering propofol in the Singapore context

Nelson Chua, Tze Wee Lee, Tsong Huey Sophia Chew, Chandra Mohan Kumar, College of Anaesthesiologists, Singapore (2022 Council)

Dear Editor, Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid...

Letter to the Editor

Sedation by non-anaesthesiologists in gastrointestinal endoscopy

Andrew Ming-Liang Ong, How Cheng Low, Christopher Tze Wei Chia

Dear Editor, We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy...

Others

Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring

M R Forster, P C Ip-Yam

The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are...

Review Article

An Overview of Anaesthetic Issues in Phaeochromocytoma

G Singh, P Kam

New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the...

Original Article

Risk Factors for Predicting Mortality in a Paediatric Intensive Care Unit

G H Tan, T H Tan, D Y T Goh, H K Yap

Following the rapid advances in medical therapy and critical care technology over the past 30 years, coupled with the spiralling cost of medical care,...

Original Article

Is it Feasible to Use Magnesium Sulphate as a Hypotensive Agent in Oral and Maxillofacial Surgery?

G M Sanders, K M Sim

Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant...

Others

Postanaesthetic Shivering—A Comparison of Thiopentone and Propofol

K F Cheong, F G Chen, G H M Yau

The incidence of shivering following general anaesthesia varies from 5% to 65%. Postanaesthetic shivering may increase tissue oxygen demand by as much as 500%...

Others

Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report

K Singh, T C Low

Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (%...

Original Article

Infections in Acute Lymphoblastic Leukaemia

C Y Chong, A M Tan, J Lou

Children undergoing chemotherapy for cancer are especially vulnerable to infection because of immunosuppression related to their underlying illness, the effects of chemotherapy and radiotherapy....

Original Article

Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore

B Macner-Licht, V Rajalingam, V Bernard-Opitz

In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has...

Commentary

Planning and Design of a Surgical Intensive Care Unit in a New Regional Hospital

C K Koay, K M Fock

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

Commentary

Management Training in Critical Care Medicine

V Kvetan

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

Others

A Case of Pseudohyperkalaemia and Thrombocytosis

T G Seah, T W K Lew, N M Chin

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

Others

Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report

P C Ip-Yam, E Allsop, J Murphy

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...

Review Article

Foregoing Life Support in Medically Futile Patients

D Y H Tai, T W K Lew

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

Review Article

Continuous Renal Replacement Therapy: Continuous Blood Purification in the Intensive Care Unit

R Bellomo, C Ronco

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

Review Article

Contributions of Respiratory Care Practitioners to Intensive Care: A Review

N C Yu, J K Stoller

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

Review Article

Nitric Oxide in Septic Shock: Directions for Future Therapy?

W M Hon, H E Khoo, S Moochhala

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

Review Article

Ventilatory Strategies for Acute Respiratory Distress Syndrome

K H Lee, T K Lim

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

Review Article

The Oxygen Delivery Debate—A Review

J Raghuram, P Eng, Y Y Ong

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

Review Article

Severity Scoring Systems in the Modern Intensive Care Unit

G Clermont, D C Angus

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

Review Article

Controlled Observations in Critical Care Medicine: The Therapeutic Trial

M R Pinsky

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

Review Article

Critical Care Medicine in the Western Pacific Region

G J Dobb

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

Review Article

Critical Care—The Worldwide Perspective

M Fisher

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

Original Article

A Retrospective Study of Infants with Severe Persistent Pulmonary Hypertension (PPHN) Managed without Extracorporeal Membrane Oxygenation (ECMO)

S P L Ng, T H Tan, J M Gomez

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...

Original Article

Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia

E Koh, I Chan, K Y Wong

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

Original Article

Use of Central Venous Lines in Paediatrics—A Local Experience

M C Chua, I LY Chan

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

Original Article

Malaria Requiring Intensive Care

K L Khoo, W L Tan, P Eng, Y Y Ong

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...

Original Article

Patients Admitted to an Intensive Care Unit for Poisoning

S Y Tay, D Y H Tai, , E Seow, Y T Wang

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

Original Article

A Retrospective Study of Near-drowning Victims Admitted to the Intensive Care Unit

K H Lee

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...

Original Article

Diabetes Insipidus in Neurosurgical Patients

M F M Wong, N M Chin, T W K Lew

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

Original Article

Outcome of Patients with Traumatic Brain Injury Managed on a Standardised Head Injury Protocol

I Ng, T W K Lew, T T Yeo, W T Seow, K K Tan, P L Ong, W M San

Trauma is the fifth commonest cause of death in Singapore. In 1996, trauma contributed to 5.4% of mortality. This article is available only as a...

Original Article

Predictors of Long-term Outcome in Severe Head Injury

Y C Lai, F G Chen, M H Gob, K F Koh

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...

Original Article

Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team

K H Lee

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

Original Article

APACHE II and SAPS II are Poorly Calibrated in a Hong Kong Intensive Care Unit

I K S Tan

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

Original Article

Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital

B L Lim, Y W Chan

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,...

Original Article

Impact on Quality of Patient Care and Procedure Use in the Medical Intensive Care Unit (MICU) Following Reorganisation

D Y H Tai, S K Goh, P C T Eng, Y T Wang

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

Editorial

Intensivists for the Intensive Care Unit—Do They Make a Difference?

T W K Lew, K H Lee, K S Ng

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

Review Article

Epidural Analgesia in Obstetrics

T K Tan

Most obstetric anaesthetists have their favourite epidural concoction for use in labour, This paper surveys the variation in techniques of drug delivery and types...

Original Article

Survey of Aerobic Bacterial Infections in Paediatric Surgical Intensive Care Unit Patients

K P L Yap, M L Tan, C E L Tan

Data on infections in paediatric surgical patients are few in the literature. Although there are many studies on infection in adult surgical and paediatric...

Original Article

An In vitro Evaluation of Epidural Catheters: Tensile Strength and Resistance to Kinking

J W Chiu, M H Goh

In the current era of increasing economic and medicolegal pressures, it is imperative that equipment-related limitations and complications be reduced to a minimum. Epidural...

Original Article

Perinatal Drug Abuse in KK Women’s and Children’s Hospital

P Agarwal, V S Rajadurai, S Bhavani, K W Tan

In recent years, perinatal drug abuse has been emerging as an area of major concern for the perinatologists. Chasnoff found the prevalence of substance...

Original Article

Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks

C S Yoong, C M Fong, S T Chan, C K Koay

Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...

Others

The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus

H S Ho, S H Lim, S Loo

A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed...

Others

Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report

K F Cheong

A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior...

Original Article

Changing the Institutional Practice of Prolonged Mechanical Ventilation after Coronary Artery Bypass Graft Surgery to Early Extubation

N C Hwang, S Shankar, B C Ong, C K Leong, E Chin, Y L Chua, Y S Tan, J Ng

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists...

Original Article

Parainfluenza Type 3 Viral Outbreak in a Neonatal Nursery

W Ng, V S Rajadurai, V K Pradeepkumar, K W Tan, K P Chan

Parainfluenza viruses are relatively large RNA paramyxoviruses. Four serologic types cause disease in humans. This article is available only as a PDF. Please click on...

Others

T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report

K S Tan, Y S Lau, W S Teo

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T...

Review Article

Controversies in Anaesthesia—Designer Drugs

F Henderson, G N C Kenny

The discovery of new drugs in anaesthesia previously relied completely on chance. Chemical compounds produced by pharmaceutical companies were screened by a variety of...

Others

The Future of Medicine from the Standpoint of the Practising Paediatrician

H B Wong

From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had...

Others

Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children

F K P Yap, M M Aw, S C Quek, S H Quak

Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are...

Others

Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report

E So, G M Sanders, T K Au, C T Hung

A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™)...

Original Article

Bidirectional Cavopulmonary Anastomosis

M L Wong, E K W Sim, J J Goh, S C Quek, J C L Wong, W C L Yip, C N Lee

Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to...

Original Article

Retinopathy of Prematurity in Very Low Birth Weight Infants

J K Chye, C T Lim, H L Leong, P K Wong

Retinopathy of prematurity (ROP), which could lead to visual impairment and blindness, is a recognised serious morbidity amongst surviving premature infants. The inverse relationship...

Original Article

Dissemination of Respiratory Secretions During Tracheal Tube Suctioning in an Intensive Care Unit

K S Ng, G Kumarasinghe, T J J Inglis

Tracheal tube suctioning is frequently performed in critically ill patients. This procedure often results in dissemination of droplets from the patient’s respiratory tract with...

Others

Echocardiographic Features and Management of Neonatal Ductal Aneurysm

T H Tan, K Y Wong, J T Heng

Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few...

Others

Perioperative Wheezing—A Report of Three Cases

P S W Yih, E H C Liu

Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration,...

Others

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

N L S H Lim

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral...

Original Article

Transaminitis in Duchenne’s Muscular Dystrophy

S K H Tay, H T Ong, P S Low

Raised aminotransferase levels, especially that of alanine transaminase (ALT), have been traditionally attributed to liver pathology rather than to muscle disorders. However, raised alanine...

Others

Twenty-four hour, Non-invasive, Neonatal Chromosome Analysis—Application in a Case of Mixed Gonadal Dysgenesis

R Quaife, S H Leong, C L W Yip, K H Chan

Chromosome analysis in neonates requires venisection and this is sometimes both difficult and distressing. In addition, results can at best take 3 days but...

Others

A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma

K S Lim, T C Low, B K Ng, C Rajasoorya

Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in...

Others

Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies

S K H Tay, P S Low, H T Ong, K Y Loke

Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of...

Others

A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block

S C Quek, K T Low, E K W Sim, R Joseph

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is...

Original Article

Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery

S H Lim, N M Chin, H Y Tai, M Wong, T K Lin

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

Others

Minimal Change Nephrotic Syndrome—A Complex Genetic Disorder

W K Gong, W Cheung, H K Yap

Minimal change nephrotic syndrome (MCNS) is the most common cause of childhood nephrotic syndrome. It is characterised by the presence of gross proteinuria, hypoalbuminaemia,...

Commentary

Transurethral Surgery and the Adductor Spasm

E L Ong, S T Chan

Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of...

Others

Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia

C L Chiu, G S Y Ong

Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes. This article is available only as...

Others

Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months

J A I Weigl

Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay,...

Original Article

DNA Testing for Fragile X Syndrome in 255 Males from Special Schools in Singapore

B S Tan, H Y Law, Y Zhao, C S Yoon, I S L Ng

Fragile X syndrome is the most common inherited cause of mental retardation, affecting approximately 1 in 1250 males and 1 in 2500 females. It...

Original Article

Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients

S C Quek, K S Ng, W L Ng, A Cheng, B L Chia

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations,...

Original Article

Total Intravenous Anaesthesia Using 3-in-1 Mixture of Propofol, Alfentanil and Mivacurium

K M Sim, S K Boey, P W S Heng, Y W Chan

Total intravenous anaesthesia (TIVA) implies achieving the 3 components of anaesthesia (hypnosis, analgesia and muscle relaxation) by the administration of anaesthetics via the intravenous...

Original Article

The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury

M H Goh, S L Yo, P C Ip-Yam

Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...

Original Article

Fibre-optic Aided Bougie (FAB) for Simulated Difficult Tracheal Intubation

J W Chiu, M H Goh, P C Ip-Yam

Difficult intubation remains a key problem1 and the value of a flexible introducer (gum elastic or wire) as a first approach is well recognised...

Others

A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix

S N Yeo, J L Chong

Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many. This article...

Original Article

Intravenous Regional Anaesthesia Using Lignocaine and Tramadol

S M Tan, L L Pay, S T Chan

Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the...

Original Article

Diagnosing and Prognosticating Acute Meningitis in Young Infants within 24 Hours of Admission

K C See, S K H Tay, P S Low

Meningitis is an important cause of fever in young infants (infants 90 days old or younger). Most cases of meningitis are acute meningitis which...

Review Article

Catheter-related Infection: Diagnosis, Prevention and Treatment

S O Heard

Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem. This article is...

Others

Book Review

J S Cheah

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...

Others

Book Review

F G Chen

This handbook serves an important function for Intensive Care Units in Singapore. It is a collective effort of 35 specialists in 5 different institutions...

Review Article

Intra-abdominal Hypertension—Implications for the Intensive Care Physician

G M Joynt, S J Ramsay, T A Buckley

Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that...

Review Article

Anaemia in the Critically Ill—The Optimal Haematocrit

I K S Tan, J M J Lim

The function of haemoglobin (Hb) is to transport oxygen to the tissues. Approximately 97% of oxygen is transported via Hb, while 3% is transported...

Review Article

Quality of Life in Long-Term Survivors of Intensive Care

T A Buckley, A Y C Cheng, C D Gomersall

Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying...

Review Article

Limitation of Life Support in the Critically Ill: The Hong Kong Perspective

T A Buckley, G M Joynt

Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly...

Review Article

Simulation-based Training at the University of Pittsburgh

J J Schaefer III, A Grenvik

In the domain of medical education of both the general public and healthcare professionals, the next decade will present both challenges and opportunities centred...

Original Article

Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock

S Basu, M Eriksson

Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of...

Review Article

Pulse Dye Densitometry: A Novel Bedside Monitor of Circulating Blood Volume

R W L Goy, J W Chiu, C C Loo

The monitoring of circulating blood volume (CBV) is important in the care and management of critically ill patients. Progressive blood volume depletion, if unmonitored...

Review Article

Enteral Nutrition of the Very Low Birth Weight (VLBW) Infant

D K L Chan

Optimal nutrition is critical in the management of the preterm infant. The fetus in utero receives continuous intravenous nutrition that is interrupted when prematurely...

Original Article

A Case Series of Six Children with Primary Pulmonary Hypertension

S C Quek, C L Yip, M L Wong, K Y Chan, C L Wong

Pulmonary arterial hypertension (PAH) is an uncommon but serious and debilitating disorder seen in children and adults. By definition, it is an elevation of...

Others

2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore

C L Tan

When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think...

Others

Case Report: Catheter-Related Epidural Abscess

S M Tay, R Lee

Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to...

Others

Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome

S C Quek, M Aw, S H Quak, K Prabhakaran, K C Tan

Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the...

Original Article

The Use of Vigabatrin in Infantile Spasms in Asian Children

S K H Tay, H T Ong, P S Low

Infantile spasms are a form of age-dependent myoclonic epilepsy that is difficult to control. Agents such as adrenocorticotrophic hormone (ACTH) and prednisolone have been...

Others

A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery

E L Ong

Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of...

Others

Subdural Block—From a Spinal? A Case Report

S Y Chan, E L Ong

There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...

Original Article

Problems Related to Epidural Analgesia for Postoperative Pain Control

J M Ng, M H Goh

Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...

Others

Clinical Update on Managing the Obstructed Airway

K F Koh

Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians...

Others

Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report

M Y H Chow, L H Tan, T Agasthian

Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems...

Original Article

Paediatric Extracranial Germ Cell Tumours: A Retrospective Review

L P N Lim, A M Tan, M Y Chan, V Rajalingam, J Lou, C L Tan

Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...

Original Article

Two-year Outcome of Normal-birth-weight Infants Admitted to a Singapore Neonatal Intensive Care Unit

W B Lian, C L Yeo, L Y Ho

With the rapid advances in the field of neonatal intensive care, the focus of interest has been on the very-low-birthweight (VLBW) infant in recent...

Others

Bronchopulmonary Dysplasia and Chronic Lung Disease of Infancy: Strategies for Prevention and Management

L Y Ho

Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal...

Original Article

Intussusception: A Three-Year Review

A H M Lai, K B Phua, E L H J Teo, A S Jacobsen

Intussusception is the most common cause of intestinal obstruction in infants and young children. It occurs when one segment of the intestines telescopes into...

Others

Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports

P C Ip-Yam, P Ruban, C Cheng, T Ravintharan

The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...

Original Article

A Prospective Audit of Critical Incidents in Anaesthesia in a University Teaching Hospital

E H C Liu, K F Koh

Despite the highest standards of training, practice and equipment, morbidity and mortality due to anaesthesia still occur. These risks are difficult to quantify, and...

Others

Severe Newborn Encephalopathy Unrelated to Intrapartum Hypoxic Events: 3 Case Reports

T C Tan, T Y T Tan, K Y C Kwek, J C S Tee, V S Rajadurai, G S H Yeo

Since Little’s article of 1862, it was popularly believed that brain damage in the majority of cases of cerebral palsy occurs during labour and...

Others

A Case Series of Pre-Viable Severe Twin-Twin Transfusion Syndrome

H Y Wee, T Y T Tan, P C Khoo, P Agarwal, G S H Yeo

Monozygotic twinning has an incidence of approximately 3.5 per 1000 pregnancies. Only 25% of monozygotic twins have a dichorionic placenta. This article is available only...

Others

Idiopathic Chronic Fetomaternal Haemorrhage Resulting in Hydrops – A Case Report

M S K Lau, J V K Tan, T Y T Tan, J M Gomez, G S H Yeo

Small amounts (<0.1 mL) of fetal blood are commonly found in maternal circulation. Massive fetomaternal haemorrhage (FMH) involves fetal blood loss into the maternal...

Others

Imaging of Paediatric Mediastinal Masses

D P Frush

A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for...

Others

The Relationship Between Scoring Systems and Cytokine Levels in Neonatal Sepsis

H Çaksen, S Kurtoglu, I K Hallaç, H B Üstünbas, K Üzüm, H Kiliç

In newborn infants, the early diagnosis of sepsis is an important problem because the early signs and symptoms of septicaemia in term or preterm...

Original Article

Clinical Characteristics of an Outbreak of Hand, Foot and Mouth Disease in Singapore

V A Shah, C Y Chong, K P Chan, W Ng, A E Ling

The enterovirus family causes a wide array of illnesses, some easily recognised clinically and others diagnosed as non-specific viral illnesses. This large family of...

Review Article

Perinatal Care at the Threshold of Viability—From Principles to Practice

L Y Ho

One of the major challenges in neonatal-perinatal medicine in the new century is the optimal management of the mother and infant when delivery is...

Original Article

Eight-year Outcome of Very-low-birth-weight Infants Born in KK Hospital

L M Daniel, S B Lim, L Clarke

The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and...

Review Article

Long-term Follow-up and Outcome of Extremely-low-birth-weight (ELBW) Infants

P Agarwal, S B Lim

With the progressive improvement in the survival of premature neonates, including those born at the extreme edge of viability, there has been a great...

Review Article

Exogenous Surfactant Therapy in Newborn Infants

G K Suresh, R F Soll

Exogenous surfactant therapy is widely used in the management of neonatal respiratory distress syndrome (RDS) and may have a role in the management of...

Others

The Use and Abuse of Steroids in Perinatal Medicine

V S Rajadurai, K H Tan

Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality....

Review Article

Mass Newborn Screening in Singapore—Position and Projections

R Joseph

Mass newborn screening is an essential preventative public health programme which aims to diagnose, in the presymptomatic phase, diseases that have a better outcome...

Others

Neonatology In Singapore: The Way We Were, The Way Forward

N K Ho

Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore....

Original Article

Chorioamnionitis and Outcome in Extremely Preterm Infants

G Fung, K Bawden, P Chow, V Yu

Preterm delivery is associated with considerable morbidity and mortality, especially among the 1% to 2% infants delivered at less than 32 weeks. Chorioamnionitis is...

Editorial

Challenges in Perinatal Medicine

V S Rajadurai

One of the significant milestones in the perinatal care in Singapore is the birth of the Perinatal Society of Singapore in March 1989. This...

Others

Predicting Significant Hyperbilirubinaemia and Early Discharge for Glucose-6-Phosphate Dehydrogenase Deficient Newborns

H H Lim, L M Daniel, J Lee, M C Tan

Glucose-6-phosphate dehydrogenase (G6PD) deficiency occurs in 2.5% of Singapore’s population, and affected newborns are at risk for severe neonatal hyperbilirubinaemia and kernicterus. In the...

Others

Autoimmune Liver Disease in Children

G Mieli-Vergani, D Vergani

Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...

Others

HIV/AIDS in Children

C Pancharoen, U Thisyakorn

The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major...

Original Article

One-stage Surgical Correction of Proximal Hypospadias

V T Joseph

Proximal hypospadias represents the most severe end of the spectrum of this abnormality. Although hypospadias itself is a relatively common condition, severe types account...

Review Article

Adolescent Health Education Programmes: Theoretical Principles in Design and Delivery

L Sanci, S Glover, C Coffey

Over the past three decades, the patterns of health need in youth have changed. Psychosocial problems such as depression, substance abuse, eating disorders, sexually...

Review Article

Art and “the Language of Well-Being” in Adolescent Health Care

P Thwaite, D L Bennett, H Pynor, H Zigmond

Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration....

Review Article

From Recreation to Creative Expression: The Essential Features of an Adolescent Inpatient Psychosocial Support Programme

K McFerran-Skewes, S M Sawyer

In 1984, the Royal Children’s Hospital (RCH) in Melbourne, Australia opened a new ward specifically for adolescent inpatients. This initiative was the result of...

Original Article

Adolescent Admissions to a Tertiary Paediatric Hospital: A Dynamic Pattern

P Y Lam, M Yeo, S M Sawyer

The nature of paediatric practice is changing worldwide. In developing countries, infant mortality from infectious diseases continues to fall with improved immunisation, medical care...

Review Article

Clinical Assessment, Management and Outcomes of a Group of Adolescents Presenting with Complex Medico-psychosocial Conditions

J E Szyndler, S Towns, R C Hoffman, D L Bennett

Increased sensitivity to biological change can make adolescents particularly vulnerable to non-organic symptomatic disorders. A variety of pains, headaches, dizziness and fatigue may remain...

Original Article

Adolescent Chronic Illness: A Qualitative Study of Psychosocial Adjustment

C A Olsson, L Bond, M W Johnson, D L Forer, M F Boyce, S M Sawyer

Chronic illness during adolescence can have significant psychological and social consequences within many life domains. Growing up with a chronic medical condition presents many...

Review Article

Strategies to Promote Better Outcomes in Young People with Chronic Illnesses

M Yeo, S M Sawyer

The epidemiology of child health in the developed world is changing. Mortality from infectious diseases has fallen sharply over the past century due to...

Review Article

Adolescent Alcohol and Other Substance Use: Sharing the Australian Experience

Y Bonomo

The most common causes of morbidity in adolescence often have behavioural or social determinants, and can have enormous social and economic consequences for adolescent...

Review Article

Sexually Transmitted Infections in Singapore Teenagers

R K W Chan, H H Tan

Adolescence can be a difficult period for many individuals who have to navigate their way through complicated emotional, psychological, physical and social demands and...

Review Article

Eating Disorders in Singapore: A Review

E K Ung

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms...

Review Article

Youth Suicide and Parasuicide in Singapore

E K Ung

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or...

Original Article

Five-Year Review of Adolescent Mental Health Usage in Singapore

N B C Lee, D S S Fung, J Teo, Y H Chan, Y M Cai

The past 20 years have seen much growth in the knowledge of child and adolescent psychiatric practice. Research has provided an improved understanding in...

Others

The Perils of Puberty

K Y Loke, R M Viner

Adolescence is a biopsychosocial maturational process, with the biological changes including completion of linear growth and sexual maturation (puberty), maturation of enzyme systems such...

Editorial

Adolescent Health—A New Perspective in Singapore

K Y Loke

In the past five decades, there have been significant advances in the fields of Paediatrics and Adult Medicine in Singapore. However, the bridging field...

Review Article

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

Tiing Leong Ang, Edwin Seet, Yaw Chong Goh, Wee Khoon Ng, Calvin Jianyi Koh, Hock Foong Lui, James Weiquan Li, Aung Myint Oo, Kieron Boon Leng Lim, Kok Sun Ho, Min Hoe Chew, Wai Leong Quan, Damien Meng Yew Tan, Kheng Hong Ng, Hak Su Goh, Wai Kit Cheong, Philip Tseng, Khoon Lin Ling

The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase...

Editorial

Ensuring safe sedation during gastroendoscopy

Eng Kiong Teo

Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were...

Others

MELAS: A Case Report

B Singh, PS Low, JF Yeo

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

Others

Characteristics of Six Newborn Infants with Postnatal Findings of Severe Intracranial Haemorrhage

JPL Wong, WT Seow, GSH Yeo

A postnatal finding of intracranial haemorrhage carries potential medico-legal implications for the obstetrician. However, one cannot exclusively attribute this to birth trauma. This article is...

Original Article

Oropharyngeal Carriage and Penicillin Resistance of Neisseria meningitidis in Primary School Children in Manisa, Turkey

H Gazi, S Surucuoglu, B Ozbakkaloglu, S Akcali, N Ozkutuk, K Degerli, S Kurutepe

Infections by Neisseria meningitidis are significant causes of mortality and morbidity in young children and adolescents. The epidemiology of serious meningococcal disease is an...

Others

Early Appendicitis – A Safe Diagnosis?

DL Loh, FD Munro, D Wilson-Storey, JD Orr

Appendicitis is the most common surgical condition of the abdomen. At laparotomy, an inflamed appendix is removed once it is found, and further exploration...

Review Article

Marijuana in Pregnancy

KM Kuczkowski

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include...

Letter to the Editor

A Fatal Turkish Case of Campomelic Dysplasia

H Çaksen, S Kurtoglu, A Öztürk

Paediatric Medicine (CD) is a rare form of congenital short-limbed dwarfism, classically characterised by campomelia (bowing of the long bones of the lower extremities)...

Others

Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context

DTW Teo, TW Lim

Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44...

Original Article

Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore

JT Lee, ZCM Lam, WT Lee, LCT Kuo, V Jayant, G Singh, J Lee

Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase...

Others

Bile Duct Perforation in Children: Is it Truly Spontaneous?

TR Sai Prasad, Chan Hon Chui, Yee Low, Chia Li Chong, Anette Sundfor Jacobsen

Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive. This article is available only as...

Others

Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome

Le Ye Lee, Swee Chye Quek, Samuel S Chong, Arnold SC Tan, Josephine MS Lum, Denise Li-Meng Goh

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first...

Others

Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article

Wan-Yee Teo, Mei-Yoke Chan, Ching-Mei Lam, Chia-Yin Chong

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital...

Original Article

Gender Disparity in Paediatric Hospital Admissions

Kam-lun E Hon, Edmund AS Nelson

Gender difference in the incidence of childhood diseases has long been recognised. but the magnitude of this effect and consistency across many disease categories...

Original Article

Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience

It-Koon Tan, Bani Gajra, Maria SF Lim

Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an...

Original Article

Does Visual Turbidity Correlate With Serum Triglyceride Levels in Babies on Total Parenteral Nutrition?

Kwang-Hsien Lim, Wee-Bin Lian, Cheo-Lian Yeo

Intravenous lipid infusion is commonly used as part of total parenteral nutrition (TPN) in newborn babies. Upon infusion, it forms an emulsion that resembles...

Original Article

Corticosteroids are not Present in a Traditional Chinese Medicine Formulation for Atopic Dermatitis in Children

Kam-Lun E Hon, Vivian WY Lee, Ting-Fan Leung, Kenneth KC Lee, Andrew KW Chan, Tai-Fai Fok, Ping-Chung Leung

Atopic dermatitis (AD) is a common, chronic inflammatory skin disease. It has been estimated that 15% of schoolchildren aged 13 to 14 years have...

Original Article

Use of Complementary and Alternative Medicine in Paediatric Oncology Patients in Singapore

Joeanne Lim, Manzhi Wong, Mei Yoke Chan, Ah Moy Tan, Vasanthi Rajalingam, Lillian PN Lim, June Lou, Cheng Lim Tan

Complementary and alternative medicine (CAM) has been gaining acceptance throughout the world. The efficacy of CAM is unproven, yet it remains popular with the...

Letter to the Editor

An Unexpected Left Hydrothorax after Left Internal Jugular Venous Catheterisation for Total Parental Nutrition and Antibiotics

Eng-Kiang Lee

Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion...

Original Article

Laparoscopic Appendicectomy in Children: A Trainee’s Perspective

TR Sai Prasad, Chan Hon Chui, Anette Sundfor Jacobsen

The advent of laparoendoscopic surgery in children has opened new avenues of treatment with added benefits but at the same time demands adequate training...

Original Article

The Epidemiology of Paediatric Intussusception in Singapore: 1997 to 2004

Irving Charles Boudville, Kong-Boo Phua, Seng-Hock Quak, Bee-Wah Lee, Htay-Htay Han, Thomas Verstraeten, Hans Ludwig Bock

Intussusception (IS) is the most common cause of intestinal obstruction in infants and young children. The peak age of presentation is 4 to 8...

Original Article

The Impact of Experiential Learning on NUS Medical Students: Our Experience With Task Trainers and Human-patient Simulation

Lian-Kah Ti, Gee-Mei Tan, Sabrina Gwendolyn MY Khoo, Fun-Gee Chen

The realisation that students have different cognitive and learning styles has had major implications on medical curriculum design efforts. If the student’s learning style...

Others

A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia

Shing-Yan Lee, Kwok-Yin Chan, Albert YW Chan, Chi-Kong Lai

Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an...

Others

Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis

Rajeev Sood, Surender Nath Wadhwa, Vikas Jain

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this...

Editorial

Paediatrics to Geriatrics: The Continuum

Hui-Kim Yap

In many parts of Asia today, paediatricians are still grappling with the childhood problems of infectious diseases, diarrhoeal diseases and malnutrition. In Singapore, it...

Original Article

Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore

Jaiman V Emmanuel, Uei Pua, Gervais KL Wansaicheong, Julian PN Goh, Ian YY Tsou

Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection...

Others

Swallowed Foreign Bodies in Children: Report of Four Unusual Cases

TR Sai Prasad, Y Low, CE Tan, AS Jacobsen

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating...

Review Article

A Rotavirus Vaccine for Infants: The Asian Experience

KB Phua, SC Emmanuel, P Goh, SH Quak, BW Lee, HH Han, RL Ward, DI Bernstein, B De Vos, HL Bock

Of all the enteric pathogens that infect young children, rotavirus is recognised as the leading cause of severe gastroenteritis worldwide. Rotavirus accounts for 20%...

Editorial

Therapeutic Hypothermia for Neonatal Hypoxic-Ischaemic Encephalopathy

VS Rajadurai

Hypoxic-ischaemic encephalopathy (HIE) is an important cause of death and later neurological disability in full-term neonates worldwide. Perinatal asphyxia causes about 19% of the...

Others

Outcome of Organic Acidurias in China

Yanling Yang, Zhang Yao, Jinqing Song, Yuki Hasegawa, Masahiko Kimura, Seiji Yamaguchi, Yuwu Jiang, Jiong Qin, Xiru Wu