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Biomedical subjects

E S Tan

Publications and source records attributed to E S Tan.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Carbon monoxide poisoning as a trigger for myocardial infarction].

A male aged 70 became unwell during work on the motor of his boat. He had an acute myocardial infarction, complicated by arrhythmias, which had probably been triggered by carbon monoxide intoxication. After treatment with, among other things, oxygen he recovered. Although the patient had experienced mild angina pectoris in the past, he had been symptom-free for years without medication. It is therefore suggested that the carbon monoxide intoxication played an important part in this case.

Aged↗
PubMed1993

Speech disorders in closed head injury patients.

UNLABELLED: Head injuries vary in type and degree of severity and clinicians agree that most individuals who suffer head injury have cognitive, speech injury, behavioural and sensory motor problems immediately after and during their rehabilitative phase. METHOD: The hospital courses of thirty-one closed head injury (CHI) patients admitted to our Rehabilitation Department from January 1990 to April 1991 were studied with particular reference to their speech disorders. RESULTS: Severity of the initial brain injury, best measured by length of coma using the Glasgow Coma Scale (GCS) was the most significant predictor of outcome, defined by the Glasgow Outcome Scale (GOS). Eighty-one percent of our patients were unconscious immediately following their injury. Upon admission into our neurosurgical department, thirty-nine percent were comatose with a Glasgow Coma Scale score of eight or less. Fifty-two percent had a score of twelve or more and the rest were in between. Twenty-six percent had skull fractures, while seventy-four percent had one or more extracranial injuries. Neurologically eighty-one percent of our patients had either a left or right hemiplegia/paresis. In the assessment of speech, thirty percent were aphasic, twenty-five percent had motor speech disorders, thirty-two percent had mixed speech deficits and thirteen percent did not have any significant speech problems. Average stay in the Rehabilitation Department was ten weeks. CONCLUSION: Although most patients showed an overall trend of speech improvement across time, the severely injured (Glasgow Coma Scale less than eight) continued to manifest permanent residual deficits especially those with expressive, mixed or global aphasia. The mild to moderately injured (Glasgow Coma Scale more than eight) seem to have anomia and word retrieval difficulty with little receptive language impairment, and these persisted months after discharge.

Adolescent↗
PubMed1993

Outcome of patients with cervical spondylotic myelopathy seen at a rehabilitation centre.

A retrospective study was conducted on 21 patients with cervical spondylotic myelopathy to study the clinical characteristics of these patients and the influence of surgery and rehabilitation on their outcome. All the patients were 50 years and above, with a mean age of 63.6 years. The most common presenting feature was weakness of all the limbs. Neckache was not a prominent finding. Although only 2 patients complained of bladder disturbance, 6 other patients were found to have bladder dysfunction after urodynamic assessment. Clinical outcome after surgery was 50% improved, 28% unchanged and 22% worsened. Fifty percent of the patients with voiding problems recovered after bladder training. Rehabilitation was significant in assisting in the recovery of patients after surgery. One patient had a disabling stroke 4 days after cervical surgery while another died of urinary tract infection while undergoing rehabilitation.

Activities of Daily Living↗
PubMed1992

Endoscopic biliary drainage for severe acute cholangitis.

BACKGROUND: Emergency surgery for patients with severe acute cholangitis due to choledocholithiasis is associated with substantial morbidity and mortality. Because recent results suggested that emergency endoscopic drainage could improve the outcome of such patients, we undertook a prospective study to determine the role of this procedure as initial treatment. METHODS: During a 43-month period, 82 patients with severe acute cholangitis due to choledocholithiasis were randomly assigned to undergo surgical decompression of the biliary tract (41 patients) or endoscopic biliary drainage (41 patients), followed by definitive treatment. Hospital mortality was analyzed with respect to the use of endoscopic biliary drainage and other clinical and laboratory findings. Prognostic determinants were studied by linear discriminant analysis. RESULTS: Complications related to biliary tract decompression and subsequent definitive treatment developed in 14 patients treated with endoscopic biliary drainage and 27 treated with surgery (34 vs. 66 percent, P greater than 0.05). The time required for normalization of temperature and stabilization of blood pressure was similar in the two groups, but more patients in the surgery group required ventilatory support. The hospital mortality rate was significantly lower for the patients who underwent endoscopy (4 deaths) than for those treated surgically (13 deaths) (10 vs. 32 percent, P less than 0.03). The presence of concomitant medical problems, a low platelet count, a high serum urea nitrogen concentration, and a low serum albumin concentration before biliary decompression were the other independent determinants of mortality in both groups. CONCLUSIONS: Endoscopic biliary drainage is a safe and effective measure for the initial control of severe acute cholangitis due to choledocholithiasis and to reduce the mortality associated with the condition.

Acute Disease↗
PubMed1992

An interactive computer program for randomization analysis of response curves with facilities for multiple comparisons.

An interactive Fortran program, MUCRA, is presented. The program can perform randomization analysis of a completely randomized or randomized-blocks design extended to growth and response curves. A single-step Scheffé-type procedure as well as the Peritz's closed step-down procedure have been implemented which control the familywise type I error-rate. In general, MUCRA is suitable as a computer tool for a distribution-free analysis of variance with repeated measures. The use of MUCRA is demonstrated by analyzing the effects oxprenolol and atenolol have on exercise heart rate. Oxprenolol is a non-selective beta-blocker with moderate intrinsic sympathomimetic activity (ISA), given by the Oros delivery system. Atenolol is a beta 1-selective blocker without ISA. A randomized placebo-controlled crossover design was used to compare the effects of the beta 1-blockers on heart rate during a progressive maximal exercise test on a bicycle ergometer. Application of the Scheffé-type procedure showed that the two drugs significantly (alpha = .05) reduce the heart rate during the exercise test at the three prechosen times (2, 5, and 24 hr) after intake. The reduction from atenolol is more pronounced than from oxprenolol Oros at 2 and 5 hr.

Adult↗
PubMed1992

Bladder training in patients with spinal cord injury.

Immediately following severe injury to the spinal cord or conus medullaris, there is a stage of flaccid paralysis of the bladder. The smooth muscle of the detrusor and rectum is affected. Drainage of the bladder is very important in the early care of such patients. From August 1989 to August 1990, 55 spinal cord injury patients were studied on admission to our department. The current bladder training method used for these patients is presented. A patient was deemed to have been successfully bladder trained when catheter-free, continent, and able to consistently maintain a residual volume of 100 mL or less with the aid of tapping and compression. On discharge 45 patients (82%) were successfully bladder trained, 8 (15%) employed a regimen of clean intermittent self-catheterization, and 2 went home/institutional care with an indwelling catheter. The material presented is applicable to any type of neurogenic bladder dysfunction.

Adult↗
PubMed1992

Hangman's fracture in Singapore (1975-1988).

A retrospective study of 33 patients with fracture of the ring of the axis (hangman's fracture) admitted to the Spinal Unit of the Department of Rehabilitation Medicine in the Tan Tock Seng Hospital between 1975 and 1988 was carried out. The aims were to establish the causes, mechanism and outcome of injuries that lead to Hangman's fracture in Singapore. The majority were males (27) and their ages ranged from 16 to 82 with a mean age of 33.7 years. 63.6% (21 cases) were due to road traffic accidents of whom 33% (11 cases) were motorcyclists or pillion riders and 30.3% (10 cases) were drivers or passengers of four wheel vehicles such as cars and vans. Using Effendi et al's classification, we have 21 type I, 11 type II and one type III fractures. Thirteen type I, 6 type II and one type III cases had no neurological deficit on admission. The rest had deficits ranging from tetraparesis to pure bladder dysfunction. After rehabilitation, 28 (84.8%) of them were able to return to gainful employment within a year of their injuries.

Adolescent↗
PubMed1992

Pyuria: index of infection in patients with spinal cord injuries.

Little is known about the significance of pyuria in patients with spinal cord injuries. The progress in hospital of 55 such patients was studied. They were divided into 2 groups according to the method of bladder drainage on admission. Group A comprised 43 patients with indwelling catheters. Group B comprised 12 patients who were able to void with tapping, with/without compression and on intermittent catheterisation. The results showed that group A had a mean pyuria level of 185 WBC/HPF on admission. The incidence of urinary tract infection was 4 per patient during hospitalisation and the mean duration of bladder training was 82 days. Group B had a mean pyuria level of 32 WBC/HPF on admission. The incidence of urinary tract infection was 1 per patient during hospitalisation and the mean duration of bladder training was 40 days. The difference between groups A and B for all 3 parameters was statistically significant. These results suggest that patients with spinal cord injuries and indwelling catheters have a higher pyuria level and an increased risk of significant morbidity secondary to urinary tract infection, especially at the pyuria level of 100 WBC/HPF. A low pyuria level of less than or equal to 30 WBC/HPF was associated with a nil or low incidence of bacteriuria and urinary tract infection in our patients.

Adult↗
PubMed1992

Measuring quantity and frequency of drinking in a general population survey: a comparison of five indices.

This article compares five indices of alcohol consumption in a general population survey conducted in 1985 in the Netherlands. Self-reports of consumption were obtained with a prospective diary, a retrospective 7-day recall method, and three summary measures, such as a quantity-frequency index. The coverage of sales data appeared highest for the diary (67%), which suggests a higher validity. Special attention was given to comparisons of quantity and frequency of drinking between the diary, on the one hand, and the weekly recall and summary measures, on the other. It was found that underreporting, relative to the diary reports, was generally higher in the frequency than in the quantity domain. This result, together with the finding from longitudinal studies that intraindividual variation is also higher for drinking frequency, leads to the conclusion that forgetting is a potent source of undercoverage in surveys and to the hypothesis that large differences in overall drinking pattern between populations (e.g., in regularity of drinking) may account for the large differences in coverage rates of sales data. Furthermore, the subjectively assessed probability of drinking by means of a "usual" frequency question appeared a poor predictor of (diary) drinking frequency for respondents reporting a low or moderate frequency. For subjects claiming a high "usual" drinking frequency, a reasonable correspondence between diary and summary measures was found. This mitigates the fear often expressed that heavy drinkers particularly underreport their consumption.

Adult↗
PubMed1992

Urinary tract infection in acute spinal cord injury.

Preservation of renal function and prevention of recurrent urinary tract infections is the ultimate goal of any method of neurogenic bladder management in spinal cord injury patients. METHOD--The hospital courses of fifty such patients admitted to our Rehabilitation Department from August 1989 to August 1990 were studied according to age, gender, spinal cord injury level, method of bladder drainage on admission and upon discharge, type of urinary tract infections and results of bladder management were documented. RESULTS--Forty-five men and ten women were studied. Mean age of males was forty and females, forty-two. The commonest cause of injury was road traffic accident followed by accidents at work place. Fifty-three percent had cervical cord injuries, thirteen percent thoracolumbar and sixteen percent lumbo sacral injuries. Seventy-eight percent had an indwelling foley catheter upon admission. Upon discharge eighty-two percent of spinal cord injury patients were able to void with/without tapping and compression. There were a total of one hundred and forty-three urinary tract infections in our study group. All positive urine cultures had greater than or equal to 100,000 CFU/ml. The commonest organisms causing urinary tract infection were Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Proteus mirabilis. CONCLUSION--For bacteria to produce disease in the urinary tract, they must gain access and colonise the uroepithelium, induce inflammation and tissue damage. The indwelling catheter provides a direct access to the uroepithelium, making bacteriuria and subsequent infection inevitable. Impaired voiding and sensation in spinal cord injury patients provides an excellent reservoir for the multiplication of bacteria, tissue invasion and recurrent urinary tract infection. Hence current methods of neurogenic bladder management have to focus on attaining a catheter-free status as soon as possible; relevant antibiotic therapy and careful attention to individual urinary tract problems to reduce morbidity and improve on spinal cord injury patient's future. Although spinal cord injury patients are described, the material covered is applicable to any type of neurogenic bladder dysfunction.

Adult↗
PubMed1991

Exercise performance during captopril and atenolol treatment in hypertensive patients.

1. Maximal aerobic exercise capacity, submaximal endurance exercise performance, and exercise haemodynamics have been studied in sixteen patients with mild to moderate essential hypertension during treatment with captopril and atenolol. 2. Administration of atenolol (1 x 100 mg day-1) or captopril (1 x 100 mg day-1) for 6 weeks resulted in similar supine and erect systolic and diastolic blood pressures. Heart rate was significantly lower during atenolol treatment. 3. Exercise heart rate and systolic blood pressure were significantly lower during atenolol than during captopril treatment, exercise diastolic blood pressure (at 100W) did not differ significantly. With atenolol exercise cardiac output was significantly lower and exercise stroke volume significantly higher than with captopril. 4. Maximal work rate, maximal oxygen consumption and maximal heart rate were significantly lower during atenolol than during captopril treatment (respectively 6%, 8% and 25%). Maximal respiratory exchange ratio and lactate concentration did not differ. 5. No statistically significant difference in submaximal endurance time between atenolol and captopril was found. Endurance time was reduced by 19% during atenolol and by 13% during captopril as compared with placebo. No difference in rating of perceived exertion between atenolol and captopril was present. 6. The results indicate that atenolol will reduce blood pressure during exercise more effectively than captopril in patients with hypertension. The limitation of submaximal endurance exercise performance by both agents is of similar magnitude. This may be regarded as an unwanted side effect in certain physically active patients with hypertension.

Atenolol↗
PubMed1991

Stroke rehabilitation of elderly patients in Singapore.

A retrospective study of 100 elderly stroke patients admitted to a rehabilitation centre in Singapore was done to study the characteristics of the patients and the factors associated with the outcome. The mean age of the patients was 72.7 +/- 5.4 years with an equal sex ratio. There was a predominance of Chinese. Two or more concomitant diseases were present in 43% of the patients with a markedly high prevalence of hypertension. Majority had unilateral motor deficit, and cerebral infarcts were seen in 66% of the scans done. Altogether 79% of the patients improved on their level of self-care in activities of daily living (ADL) while 60% showed improvement in their level of mobility. Patients with good prognosis were those who were assessed to be at least partially independent in ADL prior to rehabilitation and those who showed improvement in the motor power of their affected limbs during rehabilitation. Those with dense hemiplegia at the outset were likely to remain dependent. Age, sex, delay in rehabilitation, duration of rehabilitation, presence of dysphasia and sides of deficit had no bearing on the outcome.

Activities of Daily Living↗
PubMed1990

Doxorubicin for unresectable hepatocellular carcinoma. A prospective study on the addition of verapamil.

A prospective study was conducted to assess the safety and efficacy of the addition of oral verapamil to intravenous Adriamycin (doxorubicin) for the management of patients with unresectable hepatocellular carcinoma (HCC). All 28 patients studied had histologically verified disease, and cirrhosis was present in 20 of the 21 patients with adequate tissue sampling. The overall median survival was 57 days. Chemotherapy was terminated in seven patients after one course of treatment. Partial response and complete response were noted in four patients (19%) and one patient (4.8%), respectively, among the 21 patients evaluated. Side effects related to the chemotherapy were present in all patients studied. Death from fulminating sepsis occurred in three of the 13 patients with leukopenia. Symptomatic myocardial dysfunction developed in one patient. The addition of verapamil apparently did not potentiate the tumoricidal effect of systemic Adriamycin on HCC but probably did increase its complications.

Carcinoma, Hepatocellular↗
PubMed1990

Regularity in alcohol distributions: implications for the collective nature of drinking behaviour.

The assumption of a one parameter lognormal distribution in the Ledermann theory is relaxed. Implications of only regularity in distributional form for the collective nature of drinking behaviour are considered. It is shown that there must be a so-called point of attraction over which an increase in mean consumption will result in a decrease of percentile point value. The validity of regularity in distributional form and the practical relevance of the Ledermann model is discussed. An example from Dutch data on alcohol consumption among men obtained in 1970 and 1985 illustrates the relevance of an existing point of attraction.

Alcohol Drinking↗
PubMed1990

Comparing distributions of alcohol consumption: empirical probability plots.

Parametric approaches to the problem of the distribution of alcohol consumption have not been very successful. In this article, it is shown that regulatory in distribution can be studied without making assumptions about a distribution model underlying the data. For this purpose, a method is used with which distributions are compared graphically in so-called probability plots. It appears that, up to a proper linear transformation on a logarithmic scale, a surprisingly large regularity over time can be observed between distributions taken from Dutch samples in 1970, 1981 and 1985. Equally, distributions from male and female sub-samples do not appear to differ up to a linear shift. The finding of a relative equality in distributional form is in accordance with the Ledermann model. However, the difference with the Ledermann's model is that no assumptions about the exact shape of the distributions are being made.

Adolescent↗
PubMed1990

Use of lower limb prosthesis among elderly amputees.

Forty-seven elderly patients (21 males and 26 females) with lower limb amputation, and with prostheses fitted were studied. Their ages ranged from 65 years to 91 years old, with an average of 75.4 years. The three most common contributory causes for amputation were diabetes mellitus, vascular occlusion and carcinoma of the skin. Among the lower limb amputations, below knee amputation was the most common (93.6%). About 30% of the patients developed complications from prostheses, the 3 most common in order of frequency were stump pain, pressure ulcers and stump infection. Male patients tended to do better with prostheses than female patients. More male patients wanted prostheses for mobility, while most female patients cited cosmesis as the reason for wanting a prosthetic leg. More male patients used the prostheses more frequently and this was associated with a higher level of function in terms of self care and mobility. Reasons for non-usage of prosthesis were poor-fitting sockets, floppy stump, stump ulcers and infection. Carers of male amputees tended to cope better than those caring for female amputees. Both the present age of patient, and the age at amputation were found not to be a factor in deciding the frequency of usage of prosthesis, and the outcome of success in rehabilitation of the amputee. Psychological factors played an important role in the outcome of rehabilitation. Eighty-five percent of patients who functioned at a lower level despite a relative lack of serious medical condition cited psychological reasons for their poor performance, among which were age and the 'expected' loss of mobility with amputation.

Aged↗