Ann Acad Med Singap
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The upper airway can obstruct due to soft tissues, blood, secretions and infections. In patients who are sedated, anaesthetised or unconscious, the commonest cause is due to loss of airway muscle tone. The usual site of obstruction is the soft palate followed by the epiglottis and occasionally the tongue. ⋯ Oral and nasal airways are useful adjuncts to improve airway patency. In patients who are unconscious or adequately anaesthetised, the laryngeal mask or Combitube could be used especially in the difficult airway situation. As there is a significant decline in performance with time, it is important to maintain airway skills through regular practice and evaluation.
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Intussusception is the commonest cause of intestinal obstruction in infants and young children. ⋯ As the four classical features of intussusception were present together in only 7.5% of our patients, a high index of suspicion is necessary when any of the signs and symptoms are present in an infant or young child. Abdominal ultrasonography is the diagnostic investigation of choice. Air enema reduction was successful in 84.4% of patients and the duration of symptoms did not reduce the success rate. Thus, air enema reduction should be attempted in most patients unless they have absolute contraindications.
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Ann Acad Med Singap · Jan 2002
ReviewOsteoporosis risk factor assessment and bone densitometry--current status and future trends.
Osteoporosis and fragility fractures are problems which will increase in significance as the population of the elderly in many countries increases. The availability of bone mineral density (BMD) measurements, which can define osteoporosis, allows the implementation of effective therapeutic interventions to those at risk for fractures before they occur. Because of the increasing at-risk population and the relatively high cost of these measurements and interventions, a case-finding strategy to detecting osteoporosis has been widely recommended. This review highlights the approach to detecting and diagnosing osteoporosis. ⋯ Proper selection of individuals for evaluation and treatment for osteoporosis would include risk factor assessment and appropriate BMD measurement to determine the risk of fracture and the need for intervention.
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Most research into the problem of osteoporosis has been carried out in Caucasian populations. This review highlights emerging data from research on osteoporosis among Asians, and some differences from Caucasian data. ⋯ Many aspects of osteoporosis in Asia appear similar to the West, but several interesting differences have emerged. These might lead to refinements in the strategies to manage osteoporosis within the Asian context.
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Ann Acad Med Singap · Jan 2002
Comparative StudyDifferentiation of malignant vertebral collapse from osteoporotic and other benign causes using magnetic resonance imaging.
Elderly patients presenting with backache and vertebral collapse are a diagnostic challenge. Plain X-rays, computed tomography and radionuclide bone scans have not always reliably distinguished between benign and malignant causes. Magnetic resonance imaging (MRI) may be able to do so. ⋯ This study shows that MRI can be used to accurately differentiate between benign and malignant causes of vertebral collapse. Further differentiation between an osteoporotic, traumatic or infective cause can be done with the help of clinical history and evaluation of end-plate integrity.