Biomedical subjects

K P Pang

Publications and source records attributed to K P Pang.

9 recordsLinked to original sources

PubMed2006

Identifying patients who need close monitoring during and after upper airway surgery for obstructive sleep apnoea.

Potentially serious complications have been documented in patients undergoing upper airway surgery for obstructive sleep apnoea (OSA). Consensus is lacking regarding peri- and post-operative monitoring and identification of those patients likely to suffer post-operative complications. This retrospective review of 118 patients treated and 152 surgical procedures undertaken, from January 1998 to December 2003, addresses this issue. The overall peri- and post-operative complication rate was 13.8 per cent, with one patient experiencing upper airway compromise, five patients experiencing post-operative oxygen desaturation within 150 minutes of extubation, six patients experiencing persistent hypertension and four patients suffering secondary haemorrhage. All patients were treated accordingly and recovered well, with no mortality. From these results, it is concluded that patients with severe OSA (apnoea-hypopnoea index > 60 and lowest oxygen saturation < 80 per cent) are at higher risk of post-operative oxygen desaturation. Post-operative hypertension is more likely in patients with a prior history of hypertension. Routine post-operative admission to an intensive care unit for all OSA patients is unnecessary (including patients with severe OSA). However, all patients with OSA should be closely monitored in the post-anaesthesia care area for at least three hours after surgery; based on the outcome of this period and the clinical judgment of the clinician, the patient can then be observed overnight in either the high dependency unit or on a general ward. Patients with mild OSA may be admitted to the 23-hour ambulatory unit post-operatively. Use of continuous positive airway pressure in the immediate post-operative period can reduce the incidence of post-operative respiratory compromise and complications and is strongly recommended.

Adult↗

PubMed2005

Migration of a foreign body in the maxillary sinus illustrating natural mucociliary action.

We present a case of a foreign body which migrated to the maxillary ostia by mucociliary action from its initial location on the floor of the maxillary sinus where it was traumatically introduced. This report illustrates that a powerful mechanism of mucociliary action can cause relatively heavy objects within the maxillary sinus to migrate naturally to the sinus ostia against gravitational force.

Adult↗

PubMed2005

Migration of a foreign body in the maxillary sinus illustrating natural mucociliary action.

Adult↗

PubMed2004

Castleman's disease of the neck: a description of four cases on contrast-enhanced CT.

Castleman's disease of the neck is an uncommon benign lymphoproliferative disease that usually presents as homogeneously enhancing enlarged lymph nodes on contrast-enhanced CT scan. We described the appearance of four confirmed cases of Castleman's disease of the neck on contrast-enhanced CT scan. Three of these presented as a solitary enhancing lymph node and the fourth case presented with multiple bilateral enhancing lymph nodes. A central non-enhancing area was present in two of the three cases that presented as a solitary node. Pathological correlation of one of these cases showed that this was due to a central fibrotic scar. One of the enhancing nodes in the fourth case with multiple and bilateral lymphadenopathy also contained a central non-enhancing area. We would like to propose that if a central non-enhancing scar is observed in an enhancing lymph node in the neck on CT scan, Castleman's disease should be considered as a possible diagnosis.

Adolescent↗

PubMed2003

Pancreatitis leading to retroperitoneal fibrosis and ureteric obstruction.

Two patients who had acute pancreatitis subsequently developed characteristic appearance on urography of smooth extrinsic narrowing and medial deviation of the right ureter suggestive of retroperitoneal fibrosis (RPF) resulting in ureteric obstruction. Both these patients had clinical, biochemical and sonographic evidence of acute pancreatitis. CT scan of the abdomen performed on the second patient also documented acute pancreatitis. Intravenous urograms were consistent with ureteric obstruction due to retroperitoneal fibrosis. Both cases were treated conservatively. They were well after an average of 20 months. These 2 cases illustrate the uncommon association between pancreatitis and RPF.

Acute Disease↗

PubMed2003

Bipolar clavicular injury.

While clavicular injuries are fairly common, bipolar clavicular injuries are not. They may involve dislocations at both ends of the clavicle, or a fracture at one end and a dislocation at the other. We present two cases; a patient with a bipolar clavicular dislocation, and another with a fracture in both medial and lateral ends of the clavicle with anterior dislocation of the sternoclavicular joint. Both were treated conservatively, with fairly good range of motion and return to normal activity.

Accidental Falls↗

PubMed2002

Otitis media with effusion: an update.

Otitis media with effusion (OME) is a very common condition seen in children, and is the commonest cause of hearing loss in an infant. It is also a fairly common condition encountered by the family practitioner, and often the family practitioner is the first doctor the parents bring the child to. Otitis media with effusion is a simple condition but, if left undiagnosed or untreated, can lead to preventable long-term consequences. Hence, a high index of suspicion is necessary, early and accurate diagnosis, prompt treatment, with close follow-up is of essence. The epidemiology, aetiological factors, clinical presentations, diagnosis, various medical and surgical options, cost-effectiveness of therapy and the impact of OME on the child's development are discussed.

Age Factors↗

PubMed2001

Complete branchial fistula. Case report and review of the literature.

Branchial anomalies, a result of aberrant embryonic development, are rarely seen in clinical practice. Lesions of the second branchial pouch commonly present as a neck lump or discharging sinus that may be complicated by infection. Clinical examination often reveals the lesion to be related to the junction of the upper two thirds and the lower one third of the sternocleidomastoid muscle. Branchial fistulas often present as a discharging sinus in the neck with the fistula tract extending upward within the deep neck tissue for a variable distance. A complete branchial fistula is one that has a defined internal opening in the tonsillar area and an external opening at the skin overlying the sternocleidomastoid muscle at the junction of the upper two thirds and the lower one third of the muscle. The incidence of such lesions is extremely rare. Surgical excision is the treatment of choice for branchial anomalies. We present the case of a patient who presented with a complete branchial fistula and discuss the clinical presentation and surgical management of such lesions, with a review of the relevant literature.

Adult↗

PubMedDate not supplied

Amyloidoma of the nose in a pediatric patient: a case report.

Localized amyloidosis in the head and neck is a rare and benign disease. Larynx is the most common site of involvement and accounts for 0.2% to 1.5% of benign laryngeal tumors. The oral cavity and pharynx may also be involved in localized amyloidosis of the head and neck. There are only 7 cases of localized nasopharyngeal amyloidosis, and 8 cases of localized nasal amyloidosis reported to date. Out of these 8 cases of nasal amyloidosis, only 1 of them is a pediatric patient. We present the second reported case of localized nasal amyloidosis in a pediatric patient. This case report describes a 10-year-old girl with a 1-year history of right-sided nasal obstruction and mucoid discharge. Examination revealed an irregular erythematous, waxy gray mass arising from the right inferior turbinate. Computed tomography and magnetic resonance imaging showed the mass arising from the inferior turbinates, whereas other investigations excluded systemic amyloidosis. Histology from surgical excision revealed amyloidosis. This case illustrates that although amyloidoma of the nose is rare, it should also be considered as part of the differentials of a nasal mass even in pediatric patients. [Editorial comment: These authors demonstrate that an index of suspicion and confirmation of that suspicion through biopsy and subsequent pathologic evaluations Maybe the only way to avoid missing this potentially important cause of nasal obstruction.]

Amyloidosis↗