MyMedR

Fulltext Long-term ventilatory support in an infant with broncho-pulmonary dysplasia--a case report

Sivarajah RS, Koh MT, Tan P, Ooi SE, Ong G

Med J Malaysia, 1984 Mar;39(1):88-91.

Long-term ventilatory support of a child with bronchopulmonary dysplasia is described. Dedicated nursing care and emotional support of child and family were two important factors in the management of the child in intensive care, and in the weaning of the child from the ventilator.

Fulltext Accidental organophosphate poisoning: two case reports

Palam VSP, Abidin Z, Ong G, Loh TJ, Delilkan AE

Med J Malaysia, 1984 Mar;39(1):85-7.

PMID: 6513847

Accidental organophosphate poisoning may occur in persons coming in close contact with animals being treated toitb organophosphate pesticides. The poisoning may manifest itself as a severe systemic disorder, but can be diagnosed by an alert physician and confirmed by specific tests of reduced cholinesterase activity in the blood, plasma and red blood cells. Treatment is with intravenous atropine. Supportive measures may be necessary.

Fulltext Continuous brachial plexus block--regional anaesthesia for reimplantation surgery of the hand: a preliminary study

Sivarajah RS, Keh SA, Ong G, Teo WS, Delilkan AE

Med J Malaysia, 1984 Jun;39(2):112-5.

PMID: 6513849

Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.

Fulltext Organophosphate poisoning: a Malaysian intensive care experience of one hundred cases

Delilkan AE, Namazie M, Ong G

Med J Malaysia, 1984 Sep;39(3):229-33.

PMID: 6544925

From 1970 to 1984, 100 patients suffering from organophosphate poisoning were treated in the Intensive Care Unit at the University Hospital. These patients developed signs and symptoms of cholinergic over-activity and were treated with continuous intravenous atropine. Many of the patients also developed acute respiratory failure, which necessitated ventilatory support in the form of intermittent positive pressure ventilation. Other measures included the use of inotropes and nutritional support. Daily estimation of serum cholinesterase levels were useful in assessing degree of recovery of the patients from the effects of the organophosphates.

Major gynaecological surgery in patients with severe coronary artery disease--the combined approach

Kannan P, Sivanesaratnam V, Jeyamalar R, Delilkan A, Ong G

Aust N Z J Obstet Gynaecol, 1990 May;30(2):146-9.

PMID: 2400358

The gynaecologist today is likely to encounter elderly patients with severe coronary heart disease requiring major gynaecological surgery. The successful outcome in 2 such patients with compromised coronary circulation and impaired left ventricular function emphasized the importance of combined care with the cardiologist and the anaesthetist. The insertion of a Swan-Ganz catheter for close perioperative monitoring is vital. The intra-and postoperative problems are discussed.

Fulltext Repair of tracheal tear during oesophagectomy using the mobilised stomach

Krishnan MM, Khanijow VK, Ong G, Delilkan AE

Singapore Med J, 1991 Apr;32(2):174-6.

PMID: 2042084

Tracheal tears are not as uncommon as initially thought. The resultant insufficiency and hypoxia can be life-threatening. The keystone in management is early recognition and diagnosis. Immediate surgical repair is essential.

Severe bronchospasm during epidural anaesthesia

Wang CY, Ong GS

Anaesthesia, 1993 Jun;48(6):514-5.

PMID: 8322993

A case of severe bronchospasm occurring during epidural anaesthesia in a patient undergoing Caesarean section is described. The aetiology of the bronchospasm may have been related to sympathetic nervous blockade allowing unopposed parasympathetically mediated bronchoconstriction.

Radical hysterectomy and pelvic lymphadenectomy for early invasive cancer of the cervix - 14-year experience

Sivanesaratnam V, Sen DK, Jayalakshmi P, Ong G

Int. J. Gynecol. Cancer, 1993 Jul;3(4):231-238.

PMID: 11578351

During a 14-year period, 397 radical hysterectomies and pelvic lymphadenectomies were performed for early invasive carcinoma of the cervix. Twenty-one patients were in stage IA2 with lymphatic/vascular channel permeation (5.2%), 340 in stage IB (85.6%) and 34 in early stage 2A disease (8.5%). Eighteen patients (4.5%) were pregnant. Adenocarcinoma comprised 26.9% of cases. The mean operative time was 4.14 h; the intraoperative blood loss was less than 1.51 in 77.3% patients. There was no operative mortality; one patient died 3 weeks after surgery from clostridium difficile enterocilitis. Eleven patients (2.7%) developed venous thrombosis; severe lymphedema occurred in four (1%). The incidence of uretero-vaginal fistula was 0.2% and that of vesico-vaginal fistula 0.5%. Ovarian metastases were noted in 4.3% of cases with adenocarcinoma. Sixty-six patients had positive nodes (16.6%). Five-year survival in patients with more than 2 positive nodes was 68%. The use of adjuvant chemotherapy in patients with 'high risk' factors resulted in survival rates approaching those without risk factors. Neo-adjuvant chemotherapy was used in 10 patients with large bulky tumors; the results were favorable. Recurrences occurred in 47 patients (11.8%); 36 patients have died (9.1%). Age did not appear to influence survival. The overall 5-year survival was 92.2%.

Fulltext Evaluation of the bacteriological contamination of a closed feeding system for enteral nutrition

Chan L, Yasmin AH, Ngeow YF, Ong GS

Med J Malaysia, 1994 Mar;49(1):62-7.

PMID: 8057993

A closed enteral delivery system consisting of a cardboard tetrapack containing the sterile ready-to-use liquid feed and an independent sterile administration set, has been devised. We found bacterial contamination within 24 hours in this system in patients on ventilatory support in intensive care. This emphasises the need for meticulous care in handling enteral feeding systems to prevent environmental contamination.

Fulltext Epidural anaesthesia for caesarean section: a comparison of 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl

Wang CY, Ong GS, Delilkan AE

Med J Malaysia, 1994 Sep;49(3):269-74.

PMID: 7845278

Thirty-one healthy women who underwent Caesarean section were studied in a double-blind trial to compare the effectiveness of epidural 0.5% bupivacaine plain, 0.5% bupivacaine plus 100 micrograms fentanyl and 0.5% bupivacaine plus 50 micrograms fentanyl in the prevention of intraoperative pain. There was no difference in the quality of analgesia between the three groups. The incidence of complications was significantly higher in the 0.5% bupivacaine plus 100 micrograms fentanyl group compared with the other two groups.

Fulltext Bacterial contamination of a closed enteral feeding system: difference between laboratory evaluation and clinical experience

Ngeow YF, Chan L, Yasmin AH, Ong GS

Med J Malaysia, 1994 Dec;49(4):427.

PMID: 7674983

Fulltext Endotracheal tube ignition during CO2 laser surgery of the larynx

Chiu CL, Khanijow V, Ong G, Delilkan AE

Med J Malaysia, 1997 Mar;52(1):82-3.

PMID: 10968058

We report a case of endotracheal tube fire occurring during CO2 laser surgery of the larynx. The ignition of an endotracheal tube was thought to be caused by laser penetration of an unprotected portion of the tube during resection of vocal cord tumour. Fire hazard is inevitable when a laser is used in the path of combustible gases and in the presence of flammable objects. We discuss the methods of prevention that were used.

Out-of-hospital spinal immobilization: its effect on neurologic injury

Hauswald M, Ong G, Tandberg D, Omar Z

Acad Emerg Med, 1998 Mar;5(3):214-9.

PMID: 9523928

OBJECTIVE: To examine the effect of emergency immobilization on neurologic outcome of patients who have blunt traumatic spinal injuries.

METHODS: A 5-year retrospective chart review was carried out at 2 university hospitals. All patients with acute blunt traumatic spinal or spinal cord injuries transported directly from the injury site to the hospital were entered. None of the 120 patients seen at the University of Malaya had spinal immobilization during transport, whereas all 334 patients seen at the University of New Mexico did. The 2 hospitals were comparable in physician training and clinical resources. Neurologic injuries were assigned to 2 categories, disabling or not disabling, by 2 physicians acting independently and blinded to the hospital of origin. Data were analyzed using multivariate logistic regression, with hospital location, patient age, gender, anatomic level of injury, and injury mechanism serving as explanatory variables.

RESULTS: There was less neurologic disability in the unimmobilized Malaysian patients (OR 2.03; 95% CI 1.03-3.99; p = 0.04). This corresponds to a <2% chance that immobilization has any beneficial effect. Results were similar when the analysis was limited to patients with cervical injuries (OR 1.52; 95% CI 0.64-3.62; p = 0.34).

CONCLUSION: Out-of-hospital immobilization has little or no effect on neurologic outcome in patients with blunt spinal injuries.

Fulltext A comparison of the induction and emergence characteristics of sevoflurane and halothane in children

Chiu CL, Chan YK, Ong G, Delilkan AE

Med J Malaysia, 1999 Sep;54(3):346-51.

PMID: 11045061

This open labelled, randomised, controlled study was designed to compare the induction and recovery characteristics of sevoflurane and halothane anaesthesia in children. Forty American Society of Anaesthesiologist (ASA) physical status class 1 or 2 children (aged 1-10 year, weighed less than 25 kg) scheduled for elective urological procedure lasting less than one hour were allocated randomly to receive either sevoflurane (group S, n = 20) or halothane (group H, n = 20). The induction time in children receiving sevoflurane was significantly shorter than in those receiving halothane (mean (SD) 46 (13.6) second vs 69 (19.4) seconds, p < 0.005). The emergence from anaesthesia was also faster in children receiving sevoflurane than in those receiving halothane (mean (SD) 9 min (4.3 min) vs 21 min (8.9 min), p < 0.001). No major adverse effects were encountered in each group. We concluded that sevoflurane is comparable to halothane in Malaysian children.

Subcutaneous emphysema and pneumomediastinum after endotracheal anaesthesia

Chiu CL, Ong GS

Ann Acad Med Singap, 2000 Mar;29(2):256-8.

PMID: 10895351

INTRODUCTION: We report a case of subcutaneous emphysema and pneumomediastinum that presented postoperatively after tracheal extubation.

CLINICAL PICTURE: A 51-year-old man had an uneventful anaesthesia lasting about 6.5 hours. Intubation was performed by a very junior medical officer and was considered difficult. He developed sore throat, chest pain, numbness of both hands and palpable crepitus around the neck postoperatively. Chest X-ray revealed diffuse subcutaneous emphysema, pneumomediastinum and possible pneumopericardium.

TREATMENT: He was treated conservatively with bed rest, oxygen, analgesia, antibiotic prophylaxis, reassurance and close monitoring.

OUTCOME: The patient made an uneventful recovery.

CONCLUSIONS: We discussed the possible causes.

Fulltext A comparison of the maintenance and recovery charcateristic of sevoflurane-nitrous oxide against isoflurane-nitrous oxide anaesthesia

Chiu CL, Chan YK, Ong GS, Delilkan AE

Singapore Med J, 2000 Nov;41(11):530-3.

PMID: 11284610

To compare the maintenance and recovery characteristics of sevoflurane and isoflurane anaesthesia in Malaysian patients.

Fulltext Acute respiratory failure in melioidosis

Puthucheary SD, Vadivelu J, Wong KT, Ong GS

Singapore Med J, 2001 Mar;42(3):117-21.

PMID: 11405563

In melioidosis caused by Burkholderia pseudomallei, although every organ in the body may be involved, the highest mortality of 73% occurs when the respiratory system is affected. These patients invariably die of acute respiratory failure. Most of them also have underlying predisposing factors like diabetes mellitus.

Comparison of propofol consumption and recovery time in Caucasians from Italy, with Chinese, Malays and Indians from Malaysia

Ortolani O, Conti A, Chan YK, Sie MY, Ong GS

Anaesth Intensive Care, 2004 Apr;32(2):250-5.

PMID: 15957725

Differences in sensitivity to anaesthetic drugs may exist among different ethnic groups. Allelic variants for drug metabolizing isoenzymes and pharmacokinetic differences may account for a variable response to some anaesthetic drugs. This study was designed to compare propofol consumption and recovery characteristics in four ethnic groups: Chinese, Malays, and Indians in Malaysia and Caucasians in Italy. Patients undergoing total intravenous anaesthesia with propofol and fentanyl were evaluated for propofol consumption and recovery time. The Bispectral Index (BIS) was used to maintain the same anaesthesia depth in all patients. The BIS value, the response to verbal stimuli and eye-opening time were used to assess recovery. After propofol discontinuation the BIS values returned to baseline in 11+/-4.2 min for Caucasians, in 12.5+/-5.1 min for Chinese, 15.9+/-6.3 min for Malays and 22.1+/-8.1 for Indians. Time to eye-opening was 11.63+/-4.2 min in Caucasians, 13.23+/-4.9 min in Chinese, 16.97+/-5.2 min in Malays and 22.3+/-6.6 min in Indians. The propofol consumption was significantly lower in Indians compared to the other three groups (P<0.01). The recovery of Indians was much slower compared to Chinese, Malays and Caucasians. The recovery time of Malays is significantly slower compared to Chinese and Caucasians. Differences in propofol consumption and recovery time were not significant between Chinese and Caucasians, but the ratio recovery time/propofol consumption was significantly lower in Caucasians compared to all the other groups.

Daphnifolin, a new xanthone from Mesua daphnifolia (Guttiferae)

Ee GC, Lim CK, Ong GP, Sukari MA, Lee HL

J Asian Nat Prod Res, 2006 Sep;8(6):567-70.

PMID: 16931434

A new tetraoxygenated xanthone, daphnifolin (1,3,5-trihydroxy-4-methoxyxanthone), along with three other xanthones, were isolated from the stem bark extracts of Mesua daphnifolia. Their structures were characterized on the basis of 1D and 2D NMR spectral data.

Fulltext Moulded cement-prosthesis for osteosarcoma of the proximal humerus

Pan KL, Ong GB, Potukuchi AP

Med J Malaysia, 2006 Dec;61 Suppl B:55-7.

PMID: 17600994

We report a case of an 11-year-old boy with osteosarcoma of the proximal humerus treated with wide excision and reconstruction with a cement spacer-prosthesis. After seven years of follow-up, the patient is now almost a young adult. We present his current physical and functional status, which seems to defray the initial doubts regarding long-term problems when we chose this method of reconstruction.

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