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V H Chong

Publications and source records attributed to V H Chong.

7 recordsLinked to original sources
PubMed2006

Percutaneous endoscopic gastrostomy outcomes: can patient profiles predict mortality and weaning?

INTRODUCTION: The benefits of percutaneous endoscopic gastrostomy (PEG) remain controversial. Patient selection is important to identify those who will benefit from PEG. This study aims to identify patient factors that may help in patient selection for PEG. METHODS: Patients who underwent PEG at the Gastroenterology Unit of Tan Tock Seng Hospital, Singapore, from January 1998 to December 1999, were identified. Multiple logistic regression was used to predict patient's outcomes. RESULTS: There were 106 (61 male) patients with a mean follow-up period of 465 days (range 3-1,410 days). The mean patient age was 64.5 years (range 17-94 years). The 30-day, six-month, one-year and two-year mortality rates were 7.5 percent, 26.4 percent, 35.8 percent and 46.2 percent, respectively. Older age (p-value is 0.023), presence of bedsores (p-value is 0.042) and abnormal nutritional status based on body mass index less than 20 kg/square metres (p-value is 0.001) were predictive of mortality. 26 percent of patients were able to wean off PEG in an average period of 185 days (range 3-870 days). Patients were generally younger (p-value is 0.003) and had better renal function (p-value is 0.047). CONCLUSION: Older age, poor nutritional status and presence of bedsores were predictors of poor outcome. Younger age and preserved renal function were significant predictors of weaning off PEG feeding.

Adolescent↗
PubMed2006

Solitary rectal ulcer syndrome: characteristics, outcomes and predictive profiles for persistent bleeding per rectum.

INTRODUCTION: Solitary rectal ulcer syndrome (SRUS) is a rare disorder of defaecation and persistence of symptoms is common, particularly bleeding per rectum (BPR). This study assessed the clinical, endoscopical characteristics and predictive profiles for persistent BPR. METHODS: 28 patients (14 males) with biopsy-proven SRUS were identified from 1989 to 2003, and the clinical and endoscopical findings were retrospectively reviewed. RESULTS: At presentation, the mean age was 29.5 +/- 16.1 (range ten to 81) years. Common symptoms reported included BPR (86 percent), abdominal pain (36 percent), mucus per rectum (25 percent), straining at defaecation (25 percent), diarrhoea (14 percent) and constipation (14 percent). Digital manual evacuation was reported by 11 percent. 68 percent were anaemic and 57 percent required blood transfusion. Lesions were located anteriorly (38.5 percent), posteriorly (30.7 percent) and circumferentially (31.8 percent). The lesions were multiple (34 percent), ulcerative (64.3 percent) and polypoidal/nodular (32.1 percent). At a mean follow-up of 43.5 +/- 36 months, 64 percent (n=18) had multiple admissions (mean 3.1, range one to 12), mainly for transfusion (mean 7.4 units, range two to 27). There was no difference in clinical responses between patients with polypoidal/nodular or ulcerative lesions (p-value is 0.653). Follow-up endoscopies showed improvement (58 percent), progression (21 percent) and no change (21 percent) in the lesions. Four patients had surgery for concerns of neoplasms (n=2) and persistent BPR (n=2). BPR was persistent in 39 percent. Presence of abdominal pain (p-value is 0.008) and passage of abnormal stool (p-value is 0.002) were predictive of persistent BPR. CONCLUSION: SRUS occurs predominantly in young patients and despite being a benign condition, morbidity remains a problem. Patients' profiles are predictive of persistent BPR.

Adolescent↗
PubMed2005

Endoscopic retrograde cholangiopancreatography in the elderly: outcomes, safety and complications.

INTRODUCTION: As the population ages, the incidence of biliary tract pathologies also increases, leading to an increase in the demand for endoscopic retrograde cholangiopancreatography (ERCP) interventions. Our aims are to assess the outcomes, safety and complications associated with ERCP performed in an elderly population. METHODS: Patients aged 80 years or over referred for ERCP from January 1999 to September 2002, were identified and retrospectively reviewed. RESULTS: 103 patients (68 females, mean age 84.6 +/- 3.9 years old) underwent 144 procedures (1-6 procedures/patient). The main indications were cholangitis (51.4 percent), choledocholithiasis (19.4 percent) and blocked stents (14.6 percent). Malignancies represented 5.6 percent of indications. The mean procedure time was 38 +/- 16 minutes. The overall success rate was 80.5 percent. Minor events occurred in 23 percent (tachycardia 13, desaturation six, transient hypotension six, self-limiting bleed four, extravasations three, and mild pancreatitis one). Major events were post sphincterotomy bleeding (five days post-procedure) one, duodenal perforation one (Billroth-II gastrectomy, survived after surgery), cholangitis two, and one death was probably procedure-related (acute myocardial event five days post-stenting in a patient with Klatskin tumour). Seven deaths occurred within one month of ERCP, due to advanced malignancies (four), sepsis (two) and acute myocardial infarction (one). Patients who died within one month had significantly higher serum urea (p-value equals 0.001), and creatinine (p-value equals 0.007) levels, and lower haemoglobin (p-value equals 0.014) level. More patients had an underlying malignancy (p-value less than 0.001). In addition, they were given significantly less conscious sedation (midazolam [p-value equals 0.002] and fentanyl [p-value equals 0.018]). CONCLUSION: Our study showed that ERCP is safe in an elderly Asian population. Minor complications are usually transient and related to sedation, and mortality is usually related to severity of illness and underlying malignancies.

Aged, 80 and over↗
PubMed2005

Tuberculosis peritonitis in Negara Brunei Darussalam.

INTRODUCTION: Tuberculosis peritonitis (TBP) is uncommon and symptoms can be non-specific. Local data are lacking and our aim is to review our local experience with TBP. MATERIALS AND METHODS: Between the period of 1996 to 2004, there were 10 [male: 6; mean age, 48 +/- 18.5 years (range, 26 to 73)] cases of histologically documented TBP. Comparisons were made with pulmonary tuberculosis (PTB) patients. RESULTS: The overall prevalence ranged from 0% to 1.01% of all TB infections. The median duration of symptoms before diagnosis was 2 months (range, 3 days to 24 months). Five patients (50%) had comorbid conditions and 3 patients (30%) had a history of positive contact. Presenting symptoms were abdominal distension (70%), abdominal pain (60%), fever (60%), anorexia (60%) and weight loss (40%). Two patients had pulmonary symptoms: cough/dyspnoea (n = 1) and cough (n = 1). Chest x-ray changes consistent with PTB were seen in 30%. TBP was diagnosed by laparoscopy (n = 6), laparotomy (n = 3) and blind peritoneal biopsy (n = 1). Adverse effects of TB drugs occurred in 80%, consisting of hepatitis (n = 4), nausea/vomiting (n = 2), rash (n = 1) and encephalopathy (n = 1). Haemoglobin (P = 0.026) and serum albumin levels (P = 0.002) were significantly lower in TBP patients. There was a significantly greater number of adverse effects (P <0.001). There were no significant differences between TBP and PTB with regard to age, non-specific symptoms (weight loss, anorexia and fever) and erythrocyte sedimentation rate. All were treated with standard regimes and there were no mortalities. CONCLUSIONS: TBP is uncommon in our population. TBP patients had significantly lower haemoglobin and serum albumin levels. They also experienced more adverse events during treatment. There were no differences in non-specific symptoms between TBP and PTB.

Adult↗
PubMed2004

Clip-induced biliary stone.

Surgical clip migration is a well-known phenomenon ever since their first use in surgery. The mechanism of clip migration is poorly understood, and can occur from days to years after laparoscopic cholecystectomy. Migration of the surgical clips may be a complex process involving necrosis, pressure exerted from intra-abdominal movement, formation of stones over the exposed clip within the bile duct, and eventual migration into the common bile duct. We report two cases, a 58-year-old man and a 54-year-old woman, of clip- induced biliary stones resulting from surgical clip migration a few years after laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed2003

Advanced disseminated gastric carcinoma in pregnancy.

Gastric cancers associated with pregnancy are rare and often diagnosed at advanced stages where curative therapies are not possible. The outcomes have generally been very poor with death occurring within months of diagnosis. Suspicion and early endoscopy are necessary for early diagnosis. We herein report a case of advanced disseminated gastric cancer presenting in the third trimester with pre-eclampsia and death occurring less than a month after diagnosis.

Adenocarcinoma↗