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Biomedical subjects

K Y Goh

Publications and source records attributed to K Y Goh.

34 records · Page 2Linked to original sources
PubMed1997

The impact of teleradiology on the inter-hospital transfer of neurosurgical patients.

The aim of this study was to examine the role of teleradiology in the management of inter-hospital transfer of neurosurgical patients, especially in terms of safety and early therapeutic interventions. Data were collected prospectively, comparing events during the inter-hospital transfer of patients from a district general hospital to a tertiary neurosurgical centre, before and after teleradiology became available. From March to December 1995, 50 referrals made without teleradiology were compared with 66 referrals after teleradiology installation. Our results showed that for patients referred with teleradiologic images, unnecessary transfers were reduced (21%), more therapeutic measures before transfer were implemented (27% vs 20%, p = 0.41), adverse events occurring during transfer were significantly reduced (8% vs 32%, p = 0.002), and transfer time was shortened (72 min vs 80 min, p = 0.38). The potential advantages of this system in facilitating safer transfers and faster management of neurosurgical emergencies therefore merit further attention.

Adolescent↗
PubMed1997

Haemostatic changes during surgery for primary brain tumours.

OBJECTIVE: Primary brain tumours may be associated with coagulation disorders which can pose intraoperative and postoperative management difficulties. The aim was to evaluate the coagulation profile of patients with brain tumours undergoing surgery using thromboelastography (TEG) in combination with simple laboratory tests. METHODS: Fifty adult patients with primary brain tumours larger than 4 cm in maximum diameter and no history of coagulation disorders were studied in a prospective, observational manner over a one year period. Preoperative, intraoperative, and postoperative measurements included haemoglobin concentration, platelet count, prothrombin and partial thromboplastin times, fibrin(ogen) degradation product concentration, D-dimer concentration, and TEG. RESULTS: Eleven patients (22%) had abnormal intraoperative TEGs, of whom six (12%) subsequently developed haematomas requiring surgical evacuation. The coagulopathy seemed to be hyperfibrinolysis in two cases (4%) and disseminated intravascular coagulation in four (8%). There was no preoperative difference in reaction time (R time) for clot formation between the non-haematoma and haematoma groups(mean 11.44 (SD 3.42) v 12.33 (2.50) min, P=0.46). However, when other preoperative indices were compared, in the non-haematoma group, K time (time to reach a clot amplitude of 20 mm) was shorter (6.72 (2.15) v 10.56 (3.50) min, P=0.001), rate of clot growth (å) was faster (43.67 degrees (7.53) v 27.11 degrees (5.42), P<0.0001) and maximum amplitude of clot strength (MA) was greater (52.64 (7.85) v 40.33 (6.59) mm, P<0.001). Intraoperatively, R time was significantly shortened in the non-haematoma group, (7.67 (1.78) min, P<0.0001) unlike the haematoma group (10.67 (1.58) minutes, P=0.11). CONCLUSIONS: Although these results indicate a general hypercoagulability during brain tumour surgery, in certain cases, a predisposition towards hypocoagulability may exist even before surgery, detectable only when the physical characteristics of clot formation are studied by TEG. Judicious replacement of clotting factors, platelets, and antifibrinolytic agents should be considered intraoperatively if the TEG is abnormal, without waiting for laboratory test results.

Adolescent↗
PubMed1997

Pediatric intramedullary spinal cord tumors: is surgery alone enough?

Pediatric intramedullary spinal cord tumors occur infrequently with limited data on treatment strategies and outcome. Over an 11-year period, 44 patients with such tumors who were primarily managed by radical surgery were retrospectively reviewed. The majority of tumors (42/44, 95%) were in the cervical or thoracic spine and were histologically low grade. Gross total resection was achieved in 73% (32/44). At a median follow-up of 45 months, 11% (5/44) had severe weakness (modified McCormick scale IV-V), 66% (29/44) had mild-moderate deficits (I-III), and 16% (7/44) had sphincter dysfunction. Tumor recurrence rate was 18% (8/44) after a mean period of 54 months. Age, number of involved spinal cord segments and extent of surgical resection did not significantly impact on tumor recurrence rates (p = 0.28, 0.44 and 0.13, respectively). The only significant prognostic factor was histological type; mixed or higher grade tumors having a higher recurrence rate (p = 0.04). Radical surgery for intraspinal tumors can achieve long tumor-free survival without requiring adjuvant therapy.

Adolescent↗
PubMed1997

Intracranial vascular calcifications, glioblastoma multiforme, and lead poisoning.

A 72-year-man with previous lead poisoning presented with raised intracranial pressure and localizing neurologic signs. CT scans showed a high-grade glioma and extensive intracranial calcifications, which proved to be vascular in distribution on postmortem examination. The latter findings support the concept of dystrophic calcification following lead-induced cerebrovascular injury. Lead poisoning should be considered in the differential diagnosis of unexplained intracranial calcifications. There is also evidence from previous studies to suggest a causative relationship between lead poisoning and development of glioma.

Aged↗
PubMed1997

Optic nerve sheath fenestration for pseudotumor cerebri.

The objective of the study was to determine the efficacy of optic nerve sheath fenestration (ONSF) in eyes with progressive visual or field loss in pseudotumor cerebri in spite of medical therapy with oral Diamox. Visual data on 29 eyes of patients with pseudotumor cerebri who underwent ONSF at Bascom Palmer Eye Institute from 1987 to 1995 were studied retrospectively. These patients had progressive visual loss despite medical therapy. Visual acuity and fields were compared before and after surgery (within 1 and 6 months). During a mean follow-up of 15.7 months (range, 1-50 months), visual acuity improved in four eyes (14%), was unchanged in 22 (76%) eyes, and worsened in three (10%) eyes. Visual fields improved in 10 (48%) eyes, remained unchanged in eight (38%) eyes, and worsened in three (14%) eyes (six were lost in long-term follow-up). There were four repeat surgeries in which vision was lost in one eye. Data from these patients indicate that ONSF improves or protects visual function in patients with pseudotumor cerebri who experience deteriorating visual acuity and fields in spite of medical therapy.

Acetazolamide↗
PubMed1997

Pseudomyopia in a patient with blocked ventriculo-peritoneal shunt--a case report.

Accommodative spasm usually encompasses a classical triad of pseudomyopia, esodeviation and pupillary constriction. Accommodative spasm is most often psychogenic in nature; however, it may be associated with other organic diseases of which a rare cause is that of intracranial catheter complications. We report a case of dorsal midbrain syndrome with pseudomyopia in a patient with a blocked ventriculo-peritoneal shunt inserted for aqueductal stenosis. Clinical presentation was unusual in this patient as pseudomyopia occurred with exodeviation and without pupillary constriction.

Adult↗
PubMed1997

Cloverleaf skull--when should one operate?

Cloverleaf skull or kleeblattschadel usually occurs as a result of premature closure of the cranial sutures, with accompanying hydrocephalus, proptosis, cranial base and midface hypoplasia. The incidence of this abnormality is rare, with less than 130 reported cases in the literature, and is associated with various congenital syndromes. Conventional surgical management advocates shunting prior to definitive craniotomy and bone remodeling. We report an unusual case of Pfeiffer syndrome with associated cloverleaf skull deformity, in which early surgery was vital for decompression of raised intracranial pressure and shunt independence for the first six months. A secondary craniofacial procedure was performed at nine months of age to improve cosmesis. In such cases, good outcome can be achieved if aggressive surgery is combined with good paediatric anaesthesia and intensive care.

Acrocephalosyndactylia↗
PubMed1996

Features of pediatric head injury in Hong Kong.

Head injury in children causes special concern in most communities. From 1989 to 1994, 2,785 children younger than 16 years old were admitted to our neurosurgical service because of head injury. Fall from a height was the major cause of head injury leading to admission in infants and children in preschool age groups, whereas traffic-related or bicycle-related accidents were more likely to be the cause of head injury for those aged 11-15 years. In all age groups there was a male preponderance. The overall mortality was 0.6%. Traffic-related accidents caused more severe injury and accounted for 67% of all fatalities. For patients under 6 years old, about 40% of head injuries occurred at home. Preventive measures for pediatric head injury in Hong Kong are suggested.

Adolescent↗
PubMed1996

Water and sodium disorders following surgical excision of pituitary region tumours.

A prospective observational study of the pathophysiology of sodium and water disorders in patients with pituitary region tumours after surgical excision was carried out in 20 patients. Serial pre-operative and post-operative fluid and sodium balance, plasma and urine elctrolyte biochemistry and their derived parameters, and circulating hormones associated with fluid balance, atrial natriureic peptide (ANP) and antidiuretic hormone (ADH) were documented to correlate with the patients' clinical conditions. Ten out of these twenty cases developed diabetes insipidus (DI) requiring ADH replacement therapy, although in the majority (6 cases), this way only a transient event. Of the nine patients who developed hyponatraemia, six had symptoms such as impaired consciousness and convulsions. Four patients developed alternating hypoatraemia and hypernatraemia, which constituted a difficult group, where appropriate sodium and fluid management, and ADH replacement therapy were based upon twice daily plasma and urine biochemistry and their derived parameters. Whilst DI in this group of patients was the result of a low circulating ADH level, hyponatraemia was not associated with an exaggerated ADH activity (6.0 +/- 2.3 vs 7.4 +/- 2.3 pmol/ml, mean +/- SEM). Rather, hyponatraemia was strongly associated with an elevated circulating ANP concentration (82.4 +/- 10.5 vs 30.0 +/- 3.1 pmol/ml, mean +/- SEM, p < 0.001), resulting in salt wasting and hypovolaemia.

Adolescent↗
PubMed1996

Traumatic chiasmal syndrome: a feature photograph.

Traumatic chiasmal neuropathy results from injury to the face, sphenoid and clivus. Its pathogenesis remains enigmatic. Because of its close relationship to the pituitary gland, hypothalamus and internal carotid artery, a neuro-ophthalmic evaluation and imaging is needed in such cases. We present a patient who developed traumatic chiasmal syndrome after an automobile accident. Computed tomographic scan showed fracture of the sella turcica. A carotid angiography showed a traumatic pseudoaneurysm of the internal carotid at the base of the skull.

Accidents, Traffic↗
PubMed1995

Children's head injuries in the Vietnamese refugee population in Hong Kong.

All Vietnamese patients with head injuries from two of the largest refugee camps in Hong Kong are routinely referred to the Neurosurgical Unit of the Prince of Wales Hospital for management. In order to determine the epidemiology of head injuries in this population group, we have retrospectively reviewed all hospitalized cases over a 4 year period from January 1990 to December 1993. We have found a unique social situation in this population group, with an unusually high proportion of paediatric cases (2253 per 100,000 children aged 5 years or less), compared with other epidemiological studies. The most common mechanism of injury in between 57 and 75 per cent of cases was a fall from bed. Based on this information, appropriate preventive measures have been recommended and have successfully decreased the incidence of head injuries. This study demonstrates the value and effectiveness of epidemiological studies in identifying a previously unrecognized health risk in a specified population group.

Age Factors↗
PubMed1995

A hospital based audit of tuberculosis deaths.

An audit was done on 54 tuberculosis patients presenting to Penang Hospital who died during 1993. Active tuberculosis was the cause of death in 29 (53.7%) and 48.3% were aged under 50 years. Tuberculosis was a contributory cause of death in 8 patients and in 17 patients tuberculosis was irrelevant to the cause of death. The diagnosis of tuberculosis was made after death in 17 patients (31.5%). Late diagnosis was the most important factor resulting in death. Only 41.4% of the deaths from active tuberculosis were correctly certified in government hospitals. Medically inspected and certified deaths from tuberculosis is an unreliable indicator of tuberculosis mortality because of inaccuracies in death certification, tuberculosis deaths occurring outside hospital and tuberculosis patients undiagnosed until after death.

Adult↗
PubMed1994

Does thrombolysis affect the prognostic value of the post-infarct exercise test?

There has been some debate on usefulness of the exercise test in risk stratification after myocardial infarction in the thrombolytic era. This was assessed in 295 patients of whom 184 were treated with thrombolysis. Each had an exercise test using a modified Naughton protocol within 14 days of acute myocardial infarction. The tests were graded as high risk positive (112), low risk positive (83), or negative (100). These gradings predicted use of multiple drug therapy (p = 0.05), severity of coronary artery disease (p < 0.01), and coronary artery bypass grafting (p < 0.01). There was no influence on heart failure, recurrent myocardial infarction or death. This was independent of the use of thrombolytic therapy. The whole group had a good prognosis with a mortality of 2.4% after 56 weeks' follow-up. The exercise test is still a useful screening test after myocardial infarction. In this study, there was a high negative predictive accuracy of 91% for any event. Its use is not altered by thrombolysis. The finding of a lack of influence of the exercise test on major events may be a reflection of the current good prognosis after myocardial infarction and the prompt use of revascularisation.

Adult↗
PubMed1994

Optic nerve sheath meningioma--report of three cases.

Meningiomas involving the optic nerve and the anterior visual pathways have intrigued neurosurgeons, neurologists and ophthalmologists for more than a century. They may present with the classical triad of progressive painless visual loss, optic atrophy and opto-ciliary bypass vessels. Optic nerve sheath meningiomas are most frequently diagnosed radiologically and lately, magnetic resonance imaging has greatly improved their visualisation. Surgical removal to preserve vision has met with dismal results. We present three patients with optic nerve sheath meningiomas which were diagnosed based on radiological findings. One had improvement in her visual acuity after external beam irradiation. Another had the tumour excised by a neurosurgeon. The last patient absconded follow-up and returned with no deterioration in her visual acuity after three years.

Adult↗
PubMedDate not supplied

Is routine computed tomographic (CT) scanning necessary in suspected basal skull fractures?

The aim of this prospective observational study was to assess the yield of routine fine-cut computed tomographic (CT) scans in patients with suspected basal skull injuries. Over an 8 month period in 1994, 500 consecutive head-injured patients were examined for clinical signs of basal skull fracture and underwent fine-cut (5 mm) CT scans through the skull base in addition to standard (10 mm) cuts through the vault. Clinical signs were present in 144 patients (144/500, 28.8 per cent) of which 75 (75/144, 52 per cent) had corresponding CT evidence of fracture. A further 22 patients (22/500, 4.4 per cent) had no clinical signs but fractures were seen on CT. The presence of cranial nerve injury, cerebrospinal fluid leak, epistaxis, periorbital bruising, and two or more signs, were more likely to be associated with positive CT scans (P < 0.001, chi 2 tests). The incidence of associated mass lesions was 50.5 per cent, of which 55.1 per cent required craniotomy. This was significantly higher than in patients without evidence of skull base fracture (16.6 per cent) (P < 0.001, chi 2 27.165). Six patients, two of whom had meningitis, required surgical repair of the dural defects seen on CT. The diagnostic yield of routine fine-cut CT scans in this sub-type of head injury is 52 per cent, and is of value in detecting associated mass lesions or significant dural defects which may require surgical intervention.

Adolescent↗