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Biomedical subjects

C L Ong

Publications and source records attributed to C L Ong.

At least 19 recordsLinked to original sources
PubMed2006

Cervical ectopic thymus in an infant.

Cervical ectopic thymus, a common embryological anomaly detected incidentally at autopsy, is rarely described in clinical patients. About 100 cases have been described in the literature, ten percent of which occurred in neonates. We report a case of solid cervical ectopic thymus in a three-month-old male infant presenting as a neck lump and snoring at sleep. The embryopathogenesis, clinical features, diagnostic modalities and management options are discussed, together with a review of the literature.

Choristoma↗
PubMed2006

Clinics in diagnostic imaging (108). Tuberculous dactylitis of the thumb, mediastinal and left hilar lymphadenopathy, and probable left cervical lymphadenopathy.

A five-year-old girl presented with a history of left neck swelling for one week and right thumb swelling for three weeks. Imaging studies revealed a "collar-stud" abscess in the left side of the neck, massive mediastinal lymphadenopathy with a left anterior chest wall abscess, and right thumb dactylitis that was typical of tuberculosis (TB). Surgical drainage of the left neck swelling revealed acid-fast bacilli. Young children are more susceptible to tuberculous infection, and at greater risk of extrapulmonary spread. A child infected with TB indicates recent transmission, usually from an adult. Good contact tracing is essential. Individuals with HIV infection are also at greater risk of TB and atypical mycobacterial infection as well extrapulmonary TB. The clinical and radiological features of both pulmonary and extrapulmonary TB are discussed, with additional illustrative cases.

Child, Preschool↗
PubMed2005

Omental infarction in children: imaging features with pathological correlation.

INTRODUCTION: Omental infarction is a rare occurrence in the paediatric population. It often presents as an acute abdomen that can mimic acute appendicitis and cholecystitis. METHODS: Six cases of omental infarction in children, proven on histopathology, were retrospectively reviewed for their clinical presentation and imaging findings on ultrasonography and computed tomography. RESULTS: These cases revealed clinical and imaging findings on computed tomography that were suggestive and helpful in the pre-operative diagnosis of omental infarction. Findings on ultrasonography were less specific. Histopathological specimens revealed findings of vasculitis in all cases. CONCLUSION: There are clinical and imaging features that will help in the pre-operative diagnosis of this uncommon condition. We also postulate vasculitis as a possible underlying pathology for omental infarction.

Child↗
PubMed2004

Pitfalls of gynaecological ultrasonography.

Pitfalls in gynaecological ultrasonography may arise during acquisition of images, processing and interpretation. Physical interactions between the ultrasound and body structures may produce artifacts. Physiological processes such as functional ovarian cysts may mimic lesions. Different pathological processes may produce similar ultrasonographical appearances. To minimise errors in interpretation of gynaecological ultrasonography, one needs to be aware of the limitations of ultrasonography, and the similarities in the appearances of various physiological and pathological processes.

Diagnosis, Differential↗
PubMed2003

Foetal intralobar lung sequestration: antenatal diagnosis and management.

OBJECTIVES: The objectives of this study are to discuss the use of ultrasonography for the diagnosis of foetal intralobar sequestration (FILS) antenatally and the management options available for these pregnancies. METHODS: This is a retrospective review of six cases of FILS diagnosed antenatally by two dimensional (2D) and colour Doppler ultrasonography out of a total of 31,508 deliveries over a two-year period at the KK Women's and Children's Hospital. RESULTS: The incidence of FILS in this hospital was 1 in 5,251 deliveries. 2D ultrasonography showed an echogenic lung in all cases. FILS was confirmed by the demonstration of a systemic vessel leading to the affected lung on colour Doppler examination. After counselling, four terminated their pregnancies during mid-trimester, while two continued their pregnancies to term. Confirmation of the terminated cases was by post-mortem. In the two pregnancies that continued, regular growth scans were done to monitor the progression of the condition. Computed tomography confirmed the diagnosis post-delivery. Both were well but one had a resection of the sequestrated lung although he was asymptomatic. Histology also confirmed the diagnosis. CONCLUSION: FILS is a rare anomaly. 2D and colour Doppler ultrasonography are used to diagnose the condition antenatally. Termination of the pregnancy is not always indicated, as there are favourable outcomes from FILS.

Adult↗
PubMed2002

A case of uterine artery pseudoaneurysms.

Uterine artery pseudoaneurysms is a rare cause of haemorrhage but is potentially life-threatening and can occur after common gynaecological operations such as a Caesarean section or a hysterectomy. A 33-year-old woman who developed secondary postpartum haemorrhage after a Caesarean section was diagnosed to have uterine artery pseudoaneurysms on ultrasound scan. She was treated with bilateral uterine artery embolisation via selective catherisation of uterine arteries. Good outcome with the aneurysms remaining obliterated was obtained. Angiographic embolisation is a safe and effective method of treating postpartum haemorrhage in haemodynamically stable patients and should be an option before resorting to surgery in appropriately selected cases.

Adult↗
PubMed2000

Uterine hemorrhage in a menopausal female associated with an arteriovenous malformation and myometritis.

A case is described of vaginal bleeding in a 67-year-old female as the first manifestation of a uterine arteriovenous malformation (AVM). Although bleeding is the commonest presentation of an AVM, this is the first case known to have been precipitated by florid myometritis associated with the long-standing presence of an intra-uterine contraceptive device (IUCD). Uterine imaging studies utilising ultrasound scan with color Doppler were instrumental in suggesting the source of bleeding in this case. Subsequently, the patient suffered a torrential hemorrhage which necessitated hysterectomy.

Aged↗
PubMed2000

Ultrasonography and computed tomography in a clinical algorithm for the evaluation of suspected acute appendicitis in children.

AIM: To evaluate the roles and effectiveness of US and CT in a clinical algorithm for the evaluation of children with suspected appendicitis. METHODS: Patients with suspected appendicitis were prospectively evaluated with ultrasound (US), and in some cases with CT, after they were graded to have high, intermediate or low clinical likelihood for appendicitis. Imaging findings were made known to clinicians who then decided on a line of management. Patho-histological examination and clinical follow-up established the final diagnoses, which were correlated with the imaging findings. The effect of imaging on the management of patients was examined. RESULTS: Overall, the sensitivity of US was 92.9%, specificity 96.9%, accuracy 96.0%, positive predictive value 89.7% and negative predictive value 97.9%. Imaging did not affect the decision to operate in 13/14 (92.9%) patients in the high likelihood subgroup. Imaging guided the clinicians to the right management pathway in 26/30 (86.7%) patients in the intermediate group. 77/82 (93.9%) of US was truly negative in the low likelihood group. CT was performed in 12 patients because of unsatisfactory US scans or incompatibility between the US and the clinical findings. CT correctly diagnosed the presence or absence of appendicitis in all 12 patients. CONCLUSION: US and CT are accurate modalities in the diagnosis of acute appendicitis in children. US is most useful in patients with equivocal clinical findings. US should be the first modality used to evaluate children with suspected appendicitis. CT should be reserved for cases where US is sub-optimal or where the findings are inconsistent with the clinical findings.

Acute Disease↗
PubMed1999

Congenital lobar emphysema: antenatal diagnosis and follow up.

The case of an echogenic mass in the right lung that apparently resolved spontaneously prior to delivery is reported here. Postnatal investigations revealed congenital lobar emphysema. To the knowledge of the authors, this is the first reported case of spontaneous, apparently complete resolution of an echogenic lung mass on antenatal ultrasound due to lobar emphysema. The routine use of ultrasound to screen for foetal anomalies has led to the discovery of a number of incidental findings, such as an echogenic foetal lung mass, that pose a challenge to diagnosis and management. The importance of appropriate counselling and postnatal follow-up are highlighted.

Adult↗
PubMed1998

Preventable trauma deaths in Singapore.

BACKGROUND: This study was undertaken to determine the incidence of preventable trauma death at a non-designated trauma centre in Singapore. METHODS: A retrospective audit was carried out on all trauma deaths that occurred between January 1993 and December 1994 at the National University Hospital, Singapore. Of the 138 deaths, 38.4% (53/138) of patients were dead on arrival and were omitted from the study. Data from the remaining 85 deaths were summarized and presented before a multidisciplinary review board and injuries were scored according to the Abbreviated Injury Scale (AIS). RESULTS: Except for one patient, all deaths had an AIS score of 16 or greater. Sixty-one per cent (52/85) of deaths were the result of severe head injuries, and the rest had severe injuries in more than one body region. Following the guidelines of the Trauma Research and Education Foundation of San Diego, the incidence of 'not preventable', 'potentially preventable' and 'frankly preventable' deaths were 77.6, 15.3 and 7.1%, respectively. The most common errors in management were caused by delays in inter-departmental transfer (25.9%) and missed initial diagnosis (16.5%). After assessment by the Coroner's Office, autopsies were carried out in 60% of the cases and yielded information that altered the assessment of preventable deaths, particularly in the group with multiple injuries. CONCLUSIONS: The present study concludes that the preventable death rates in the National University Hospital are comparable to those in non-trauma designated centres elsewhere. There can only be a decrease in the preventable death rate if an improved system of pre-hospital trauma care, improved interdisciplinary communication, closer supervision of the initial attending physicians and stricter protocols on clinical monitoring are established.

Abbreviated Injury Scale↗
PubMed1998

Intramural tubal polyps--a villain in the shadows?

BACKGROUND: Intramural tubal polyps are commonly described in association with subfertility. However, there is unfamiliarity among clinicians about the investigations available for making a diagnosis of this condition. The objective of this paper was to highlight the suitable investigations for diagnosis and thus increase awareness of this condition and its relationship with subfertility. METHOD: A retrospective review of 14 patients with intramural tubal polyps was done for the period from January to December 1996. An attempt was made to correlate the radiographic findings on hysterosalpingography with transvaginal ultrasound examinations and hydrochromotubation performed under laparoscopic observation. The fertility history of these patients was also examined. RESULTS: The review demonstrated a prevalence of 3.8% of intramural tubal polyps in a selected population of predominantly subfertile women. Only hysterosalpingography was useful in making the diagnosis in-vivo. Fifty percent of the patients did not have any other obvious pathology to explain their subfertility. CONCLUSION: We conclude that meticulous hysterosalpingography is useful as a diagnostic investigation and that consistent reporting is needed for good follow-up.

Coloring Agents↗
PubMed1998

The effect of enteral fibre-containing feeds on stool parameters in the post-surgical period.

BACKGROUND/AIM OF STUDY: Specialised nutritional support includes both enteral and parenteral routes. When oral intake is not an option, but gastro-intestinal function is present, enteral tube feeding should be considered. However, one of the complications of enteral feeding access is diarrhoea. The aim of this study was to test the effect of fibre on a local population, in a prospective, single-blinded trial to determine whether the presence of fibre in enteral feeds reduced the incidence of diarrhoea in Asian patients. METHODS: Sixteen post-surgical candidates were randomly assigned to receive a fibre-supplemented (FSF) enteral formula or a fibre-free formula (FFF) for 10 days post-surgery to assess the usefulness of FSF in reducing the incidence of diarrhoea in tube-fed patients. Differences in stool consistency, stool frequency, capillary blood glucose and serum albumin levels between the two groups were determined. Antibiotic usage in both groups was noted. RESULTS: Patients in the FSF group had more bowel movements throughout the 10-day period and firmer stools than the FFF group, but this difference was not statistically significant (p = 0.39). There were no significant differences in daily mean glucose levels between both groups. CONCLUSION: We conclude that there is insufficient evidence that fibre-containing enteral formulae reduce the incidence of diarrhoea in tube-fed patients in the short term. However, these products could inherently be included for patients on tube-feeds during extended periods, with the prospect of maintaining gut function integrity and flora.

Adult↗
PubMed1998

Necrotising fasciitis originating from a vulval abscess--a case report.

This article reports a rare case of necrotising fasciitis starting out as a vulval abscess with rapid progression to a potentially lethal condition. Elderly people with medical conditions such as diabetes are especially prone to it. A high index of suspicion and an early surgical consult are essential in improving outcome in this condition. Once diagnosed, aggressive surgical debridement with antibiotic cover is crucial. This is followed up with meticulous nursing care of the large wound till it heals. The various diagnostic points and treatment modalities are also discussed.

Abdominal Muscles↗
PubMed1997

Cystic hygroma in adulthood.

The majority of cystic hygromas present in childhood, usually below the age of two years. A case report of adult presentation is presented, with discussion of development, presentation, pathology and management of cystic hygroma.

Adult↗
PubMed1997

Surgical Nutritional Team and its impact on total parenteral nutrition in The National University Hospital, Singapore.

The Surgical Nutrition Advisory Team (SNAT) of our hospital, formed in October 1992, decided to study the impact of such a team on the six months before and after its formation on catheter care and nutritional support in total parenteral nutrition. Our study showed that with a dedicated nutritional team, catheter sepsis was reduced from 35.1% to 15.4%. The median lifespan of central catheters was increased from 7 to 11 days. Mechanical complications were reduced from 11% to zero. Better patient selection resulted in more severely malnourished patients receiving preoperative nutrition and fewer postoperative patients being started on total parenteral nutrition. Better monitoring of nutritional requirements, electrolyte and metabolite levels and consequently faster correction of abnormal blood levels, were also obtained.

Bacterial Infections↗
PubMed1995

Clustered intramammary microcalcifications not associated with a mass.

Over a period of two and a half years, 36 biopsies performed for clustered microcalcifications not associated with a mass revealed 30 benign and 6 malignant lesions. Of the 30 benign cases, 4 showed histological features which are thought to be associated with an increased risk of developing carcinoma. As similarities can exist in the mammographic appearances between benign and malignant microcalcifications, clusters of microcalcifications showing overlapping features or increasing in number over time require histopathologic study as there is no radiologic means at present of predicting which cluster will be malignant. We observe that our Chinese female population has a tendency towards dense breast parenchyma often associated with microcalcifications, both scattered and clustered. The presence of these clustered microcalcifications prompts biopsy even though the yield for malignancy is anticipated to be low.

Adult↗