ABSTRACT
BACKGROUND: Recent international guidance recommends the use of catheter-directed thrombolysis (CDT) in selected patients with symptomatic iliofemoral deep vein thrombosis (DVT). The aim of this study was to estimate the potential increase in workload as a result of this recommendation. METHODS: Using the radiology database, a review was performed of all DVTs diagnosed between August 2010 and February 2012 at a large tertiary referral hospital. The National Institute for Health and Clinical Excellence and American College of Chest Physicians guidance was applied retrospectively to this cohort, using case-note review by two independent clinicians to determine which patients would have been suitable for CDT. RESULTS: Some 563 patients had DVT confirmed radiologically over the 18-month interval. Fifty-three of the 128 patients with iliofemoral DVT would have been eligible for intervention with CDT, equivalent to 4·4 patients per 100 000 per year. Only eight (15 per cent) of the 53 were actually referred to vascular services for treatment. All eight patients had successful CDT, which involved a stay in critical care for monitoring (median 2 (range 1-3) sessions). CONCLUSION: Vascular units should be prepared for a major increase in the requirement for CDT for iliofemoral DVT. This increase will affect inpatient beds, the interventional radiology suite, critical care and interhospital referrals.
Subject(s)
Catheterization, Peripheral/methods , Femoral Vein , Iliac Vein , Thrombolytic Therapy/methods , Venous Thrombosis/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Care/statistics & numerical data , Female , Hospitalization/statistics & numerical data , Humans , Lower Extremity/blood supply , Male , Middle Aged , Retreatment/statistics & numerical data , Retrospective Studies , Thrombectomy/methods , Thrombectomy/statistics & numerical data , Venous Thrombosis/etiology , Workload , Young AdultABSTRACT
AIM OF STUDY: To review the incidence, morbidity and mortality of Meconium Aspiration Syndrome (MAS). To identify possible predictors of MAS in newborns with thick meconium-stained amniotic fluid (MSAF) at delivery. METHODOLOGY: Case records of babies with MSAF delivered in Singapore General Hospital from 1.1.1991 to 31.12.1993 were studied retrospectively. RESULTS: In the study period, 1,893 babies (15% of live births) had MSAF and 174 babies (1.4% live births) developed MAS. The incidences of MAS in newborns with light, moderate and thick MSAF were 0.3%, 5.8% and 61% respectively. Complications associated with MAS were metabolic acidosis (52%), air leak syndrome (2%), persistent pulmonary hypertension (2%) and hypoxic ischaemic encephalopathy (0.5%). The mortality rate of babies with MAS was 2%. Newborns with thick MSAF were more likely to develop MAS if they were males, small-for- gestational-age, had fetal distress and meconium was sucked from the trachea at birth. CONCLUSION: Vigilant perinatal monitoring of high risk babies with MSAF and proper resuscitation at birth would help reduce the incidence of MAS and its associated complications.
Subject(s)
Meconium Aspiration Syndrome/etiology , Female , Hospital Mortality , Hospitals, General , Humans , Incidence , Infant, Newborn , Intensive Care, Neonatal , Male , Meconium Aspiration Syndrome/therapy , Morbidity , Predictive Value of Tests , Retrospective Studies , Risk Factors , SingaporeABSTRACT
This report describes a 5-year 6-month-old Chinese girl with partial monosomy for the long arm of chromosome 22. The karyotype was 46,XX/46,XX,del (22) (q13.2). She presented with global developmental delay. Clinical features include seizures, failure-to-thrive, prominent ears, long philtrum and abnormal skin pigmentation on the face and limbs.
Subject(s)
Chromosome Deletion , Chromosomes, Human, Pair 22 , Intellectual Disability/genetics , Child, Preschool , Female , Humans , KaryotypingABSTRACT
Between 1992 and 1994 the Paediatric Metabolic Centre screened 403 patients for inherited metabolic disease. Seventeen patients were diagnosed, including 7 with organic acidurias, 5 with mucopolysaccharidoses, 2 with amino acid disorders, 2 with carbohydrate disorders and 1 with hyperlipidaemia. The ethnic distribution of disorders in Singapore is compared with incidences reported by others in this part of the world. It is likely that further studies will indicate which diagnostic or screening tests would best serve this community.
