A study of 8 year neonatal deaths (1982-1989) of Toa Payoh Hospital

A study of 233 neonatal deaths out of 30910 livebirths over an 8 year period in the Toa Payoh Hospital is done. The Hospital has since ceased providing obstetric and neonatal intensive services from April 1990 due to restructuring of hospital care. The Neonatal Mortality Rates (NNMR) from 1982-1989 ranged from 6.52 to 9.55 and there was no significant fall in trend (p = 0.13). One hundred and thirteen (48.5%) neonates who died were below 1500gm (VLBW). Various causes of neonatal deaths were examined and there was a decline in respiratory distress syndrome (RDS) death rates (p less than 0.0002). Deaths due to asphyxia (p greater than 0.05) and infections (p greater than 0.05) have not declined significantly over the same period. It is also observed that less VLBW babies died over this 8 year period and the VLBW mortality rates (p less than 0.02) have declined. However, the congenital malformation mortality has also not declined significantly (p = 0.92) though early study (1972-1981) showed an increasing trend of malformation deaths among total neonatal deaths (p less than 0.02). Improvement in VLBW and RDS management has not contributed to a significant decline in NNMR. It is observed that more VLBW babies were born during this 8 year period (p = 0.01) especially so in the less than 1000 gm group (p = 0.0005) and the survival of VLBW babies has improved (45.5% to 75.8% alive) as a result of advances in neonatal intensive care. The reasons for increase in incidence of VLBW births in the past few years are not known.(ABSTRACT TRUNCATED AT 250 WORDS)     

Six years experience of angioedema at the University Hospital of the West Indies

Angioedema (AE) is a problem that all doctors inclusive of emergency room physicians and the otolaryngologists are often asked to treat. We present a six-year experience with this disorder. In this series, angiotensin-converting enzyme inhibitors (ACEIs) were related to 60% of admissions for angioedema. Lip and tongue swelling was the most common manifestation. The discontinuation of ACEI therapy and supportive management are the recommended approaches to treatment and prevention of unfavourable outcomes. The authors strongly recommend medic alert bracelets for all patients with this disorder. The use and side effects of ACEI therapy in our population which is predominantly of African descent warrants further investigations.     

Paediatric day care anaesthesia--our first two years experience at the Paediatric Institute, Hospital Kuala Lumpur

The first two years anaesthetic experience of paediatric day care surgery is reviewed. Four hundred and three patients underwent 447 general surgical procedures. The mean age of the patients was 5.4 years with the youngest being 5 months old. The commonest procedures performed were herniotomy, circumcision, correction of hydrocoele and orchidopexy. The overall postoperative admission rare was 2.5%. No major complications were seen. Anaesthesia for paediatric day care surgery is safe provided patients are carefully selected and evaluated, appropriate anaesthetic management instituted and proper discharge criteria adhered to.     

Ten years of snake bites at Fremantle Hospital

Seventy-six patients (30% children) were admitted to Fremantle Hospital over 10 years with suspected snake bite. Twenty-nine patients were definitely bitten, with 26 bites being witnessed. Of the 13 patients definitely envenomated, 11 had a coagulopathy although seven were asymptomatic; four other patients may have been envenomated. The dugite (Pseudonaja affinis) was probably responsible for most envenomations. Eleven of the 13 envenomated patients received antivenom (six brown snake, four polyvalent and one tiger snake antivenom). The patient envenomated by the tiger snake (Notechis ater occidentalis), a 13-year-old girl, was initially incorrectly treated with brown snake antivenom at a country hospital, and did not receive appropriate antivenom until 50 hours after the bite. She developed profound paralysis, rhabdomyolysis and renal failure, and required prolonged ventilation during her 53-day hospital admission, but survived without disability. Snake bite wounds should not be washed, so that venom can be identified from the wound. Attempts to kill snakes are dangerous, often leading to bites on the fingers. First aid measures of a pressure bandage and immobilisation, used in 13 of the 29 cases (45%), should be more widely publicised.     

Phacoemulsification : our experience at a large Military Hospital

Cataract surgery by means of phacoemulsification was started at a large Military Hospital in March 2001. First 70 cases in whom phacoemulsification was performed between 15 March 2001 and 31 December 2001 were followed-up and evaluated. The surgical techniques used, complications and post-operative recovery following this new surgical technique have been discussed. Our experience of conversion from standard extracapsular cataract extraction to phacoemulsification has also been shared.Key Words: Astigmatism, Continuous Curvilinear Capsulorexhsis, Phacoemulsification, Posterior Capsular Rupture     

Ewing's sarcoma: fifteen years' experience at Angau Memorial Hospital

A retrospective study was carried out on Ewing's sarcoma as seen between 1973 and 1987 at the Cancer Treatment Centre, Angau Memorial Hospital, Lae, Papua New Guinea. Some striking differences were observed in the epidemiological indices and the clinical picture of this disease here, when compared with other centres in the world. Most notably, Ewing's sarcoma, hitherto a rare tumour in this country, seems to be on the increase. In addition, among the flat bones, involvement of the scapula was disproportionately high. The early response to treatment was similar to findings elsewhere, although the long-term patient follow-up in this series was not satisfactory enough to allow proper estimates of long-term survival rates. The most recently advocated approach to the management of Ewing's sarcoma, which emphasizes surgery in preference to radiotherapy for local disease control, and adjuvant chemotherapy for micrometastases, is outlined.     

A case of Lassa fever: experience at St Thomas's Hospital

An 18-year-old Nigerian girl, normally resident in Jos, was admitted to hospital for five days before she was diagnosed as having Lassa fever. There were several atypical features in the early stages of here illness, notably the absence of prostration, pharyngitis, or bradycardia and the development of appreciable leucocytosis. Consequent control and surveillance measures required checks for 21 days on 173 people who had had contact with as first line if they had handled her or specimens without taking precautions to avoid direct skin contact with her excretions, secretions, and blood; other contacts were categorised as second line. During her time in hospital she was managed in a single room on a general ward. She visited a number of investigative departments within the hospital, and her specimens were examined in five clinical laboratories. Despite this no secondary cases occurred among either first- or second-line contacts, and there was no serological evidence of subclinical infection among any of the contacts tested (159 people).     

住院药房管理的体会

凡是有住院部的医院,都应设立病区住院药房,住院药房工作担负患者用药安全的重要环节,在确保药品质量及供应发挥作用。住院药房作为医院重要的组成部分,工作的好坏直接影响到医院的形象和经济效益,所以加强住院药房管理在医院管理中占举足轻重的地位。本文阐述了作者在2005年7月~2010年7月五年间在住院药房管理过程中所遇到的一些问题以及遇到问题实行的措施,加以总结,探讨如何更加有效规范住院药房管理、提高药学人员素质、保障患者用药安全并为患者提供高品质的药学服务,按三级医院住院药房的标准执行,为我院"三乙"的评审打下良好的基础。     

Eight years study of Sudanese renal allograft recipients at Soba University Hospital

Forty sudanese renal allograft recipients were followed up at Soba University Hospital (SUH), Khartoum, Sudan, for varying periods between January 1978 and October 1985 accruing 1417 patient-months of observation. 21 transplant operations were done in United Kingdom, 11 in Kuwait, 1 in Sudan, while the rest were done in other European and Arab countries. There were 27 males and 13 females with the age ranging between 10 and 48 years with a mean of 30.15. Thirty eight patients received live related (LR) donor kidneys and two were transplanted with cadaver kidneys. Four patients had a second graft because of early loss of the first. Seven patients died, 3 because of chronic rejection, 3 had severe intractable diarrhoea and one died because of an unrelated cause. The 30 patients who had their transplantation 2 years ago or more were studied for the 2-year survival. Twenty seven of these were alive and well with functioning grafts giving a patient and graft survival of 90%. The complications encountered are discussed.