The burns scene in Singapore--past, present and future.
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Burns↗
Biomedical subjects
R C Ngim
Publications and source records attributed to R C Ngim.
The burned ear (I): An experimental study with the rabbit model to evaluate scalding temperature, surface and histopathologic appearance, and healing responses with depth of injury.
There are few papers on experimental burns of the external ear. An experimental model was made and a study was conducted on 18 white rabbits to evaluate the response of the rabbit ear in relation to temperature, surface and histologic appearances and healing response with depth of injury. The rabbit model showed that: a) the rabbit ear resembled that of the human ear in histological structure. b) there was a definite correlation of the temperature of the scalding agent with the depth of the injury. c) it was possible to classify morphologically the depth of injury based on surface appearance. d) there was an accurate morphologic correlation with that of histopathologic assessment of burns depth. e) the sequential biopsy at different times (immediate, third, fifth day) showed that the depth of the burns was already apparent soon after the injury. f) there was also a correlation of burns depth with the rate of ear healing.
Adult↗
The burned ear (II): A prospective clinical study of 100 patients with 150 ear burns.
A prospective clinical study of 100 patients with 150 ear burns was carried out in the Burns Centre, Singapore General Hospital. The aims of this study were to document the nature of the injury, the results of various methods of treatment, the complications of ear burns and the changes that led to chondritis. Based on the findings of the experimental studies on the burned ear, it is possible to accurately classify the depth of the burn injury based on the surface appearance. The results show that fire was the commonest aetiologic agent for ear burns (65% cases) and hot water scalds second (25% cases). Scalds tended to cause unilateral ear burns whilst fire caused bilateral injuries. The single most important factor in healing of the burned ear was the depth of the injury. Erythema took six days, mid-dermal (MD) burns ten days, uncomplicated deep-dermal (DD) and full thickness (FT) burns 35 days. When chondritis developed deep dermal burns took 43.5 days to heal and full thickness burns took 57.8 days. Conservative treatment of 104 ears resulted in complete healing except for 15 which had pigmentary and/or hypertrophic scar problems. Surgical treatment was used in 23 ears. Three returned to normal appearance, eleven had mild and four had moderate deformities. Five ears were lost (3% cases). Chondritis was present in 12 ears (8% cases), six in DD and six in FT burns. Seven of these ears were successfully salvaged. Favourable results in this study were attributed to the following factors: early detection of chondritis by the EAR SPRINGING SIGN, early surgical intervention, radical cartilage removal, meticulous post-op care to prevent cross infection and avoidance of pressure to the ears.
Adolescent↗
Anatomy of a burns disaster: the Miri Bank explosion.
A bank explosion in a neighbouring country over 1000 km away resulted in ten badly burned victims being airlifted to the Burns Centre, Singapore General Hospital (BCSGH) for treatment. The severely injured included patients with 90%, 80%, 74%, 66%, 45%, 33% and 31% burns. Nine had respiratory burns (four severe, one moderate, four mild). One patient died, thus, the mortality rate for the six most severely injured was 16.7%. This differs from predicted mortality rates of 78% according to McCoy or 54% according to Thompson, Herndon et al. The factors contributing to this result were the small size of the disaster, the use of an established Burns Mass Disaster plan and an individual management policy that incorporates carefully monitored fluid resuscitation, recognition of respiratory burns with early treatment by intubation thus pre emptying complications, early surgery and a multidisciplinary approach to complications such as infection and renal failure. The average length of stay was 43 days (range 5-122 days). The cost of the hospitalisation of the ten casualties was $312,317.00.
Adult↗
Epidemiology of burns in Singapore children--an 11-year study of 2288 patients.
A retrospective review of 2288 children (12 years and below) admitted to the Burns Centre, Singapore General Hospital over an eleven year period (1978-1988) was made. Annual admissions from 1978-85 ranged from 208-290 cases annually (32-38% of all admissions). Between 1986 to 1988 annual admissions ranged from 73-104 cases annually (22-28% of all admissions). There was a reduction of number as well as proportion of children admitted. The main reasons for this change in trend were due to the successful nationwide campaign on fire and home accident prevention, change in admission policy and introduction of newer dressings to treat smaller burns. Boys accounted for 62% admissions. Toddlers between the age of one to two were most vulnerable (26% admission) and children under three years of age accounted for 50% admissions. Eighty-five percent of burns admitted were 10% or less. Length of stay ranged 8-12 days. The commonest cause of injury was scalds (90%) and flame burns (6%). Flame was responsible for the death of six children and scalds of three children. There were nine deaths in this series giving a mortality of 0.4%. Children mortality contributed to 5.6% of total mortality seen in our burns centre. Age per se did not contribute to a higher mortality. There was a definite correlation of mortality to extent of burns. Only one child died from burns of less than 40%. Case mortality in the 40-60% burns group was around 20% and it increased sharply when extent of burns reached or exceeded 70%. Burns in children exhibit anatomical, physiological, surgical, rehabilitative and psychological differences when compared to adults.
Burns↗
Hypopituitarism following head injury--a case report.
A 16 year-old boy sustained fracture of the floor of the right orbital fossa in a road traffic accident with resultant diplopia and right enophthalmos. Symptoms of hypocortisolism subsequently developed. About two years after the trauma, pubertal changes which had occurred at 13-14 years had completely regressed. Endocrine testings confirmed clinical anterior hypopituitarism. Post-traumatic hypopituitarism may follow injury to the hypothalamus, the pituitary stalk or the pituitary itself. The normal thyroid stimulating hormone (TSH) response to thyrotropin releasing hormone (TRH) in this patient is in favour of a hypothalamic lesion. The patient has responded to replacement hormonal therapy.
Accidents, Traffic↗
The fourth dimension of the face: a preliminary report of growth potential in the face of the Chinese population of Singapore.
Age-related changes were studied in 32 linear measurements from the faces of 180 healthy Chinese subjects of Singapore, aged 6, 12 and 18 years, with equal representation of the sexes. In addition, the differences in 10 inclinations and 6 angles of the facial profile between thirty 6-year-olds and thirty 18-year-olds of each sex were determined. The total absolute and relative growth between 6 and 18 years was established and, in the linear measurements, the relative increments were separately calculated for the 6- to 12-year-old and 12- to 18-year-old periods.
Adolescent↗
Measuring the cleft deformity.
Comparative studies in cleft lip and palate patients are difficult because of the difficulty in documenting them. Both qualitative assessment and quantitative measurements are needed so that a more meaningful comparison of long-term results could then be made. The different protocols used previously by various authors were reviewed and a protocol was drawn up for the Department of Plastic Surgery, Singapore General Hospital. This was used for a trial period and then revised. The difficulty in measurement lay mainly in determining the accurate anthropometric points on the face from which measurements were made.
Cephalometry↗
Speech and nasendoscopic evaluation of velopharyngeal incompetence (VPI) in cleft palate patients.
Cleft lip and palate patients exhibit several problems prior to and following surgical repair of their deformities. Hypernasality and speech defects remain one of the outstanding problems. 82 cleft palate patients were subjected to a systematised speech evaluation and an examination of the velopharyngeal mechanism. Nineteen patients did not have any surgery of the palate whilst the remaining 63 had at least one surgical procedure to the palate. 54 had a Veau-Wardill-Kilner (V-W-K) procedure and the remaining had either a second palatal repair or a superiorly based pharyngoplasty. Good correlation of speech assessment to nasendoscopic evaluation was found. An improvement in the speech and nasendoscopic coding was found in patients who had surgical intervention to the palate. A nasendoscopic examination, ideally performed by the surgeon and a speech therapist, is a useful adjunct to speech evaluation.
Adolescent↗
Postburn nailfold retraction: a reconstructive technique.
Postburn nailfold retraction often results in nail deformity and loss of distal interphalangeal joint flexion. A technique of reconstruction of the nailfold using a proximally based transposition flap is described in a patient with postburn nailfold retraction of the left thumb, index and middle fingers.
Adult↗