A tracheostomy is a procedure involving stoma creation through the skin and into the trachea. It can be done surgically or via a percutaneous dilatational technique.1 A tracheostomy tube is the piece of equipment that is left in situ. There is an increasing number of patients with tracheostomy tubes living in the community in Singapore. Therefore, it benefits community physicians to be aware of some aspects of tracheostomy tube components and change. This article will cover indications and contraindications, components, complications and provide an overview of tracheostomy tube change in the community setting.

No abstract available.
Pneumothorax* ; Thoracotomy*

Pacemaker-mediated tachycardia(PMT) is a circus movement tachycardia that can occur in patients with dual chamber pacemaker with atrial sensing(VDD or DDD), when a ventricular depolarization, either spontaneous or paced, causes retrograde activation of the atrium. Recently, a number of pacemaker manufactures have incorporated in their devices a variety of relatively complex algorithms to prevent PMT. Despite these measures, PMT may still occur because of inappropriate programming or unpredictable variations of ventriculoatrial conduction. We report one case of PMT in a 78-year-old male who received DDD type pacemaker due to sick sinus syndrome. In this case, PMT was disappeared after reprogramming parameters of pacemaker and the application of PMT protection algorithm.
Aged ; Dichlorodiphenyldichloroethane ; Humans ; Male ; Sick Sinus Syndrome ; Tachycardia*

Atrial myxomas are uncommon, but surgical treatment offers a potential cure. Early diagnosis is essential so that tumors can be promptly removed in order to reduce morbidity or mortality from atrioventricular valve dysfunction and embolic complications. They are intracavitary tumors occurring within any of the cardiac chambers, but they have a predilection for the atria, particulary the left atrium. The development of noninvasive, echocardiogaphic technique has made it possible to screen large numbers of patients with atrial myxoma with ease and safty. Recently the development of diagnostic procedure and cardiac surgery increased the accuracy of diagnosis and the opportunity of successful ereatment. We report the two cases of left artial myxomas which were removed successfully by surgery.
Diagnosis ; Early Diagnosis ; Echocardiography ; Heart Atria ; Humans ; Mortality ; Myxoma* ; Thoracic Surgery

This paper is intended to draw attention to the cases of non-union of reattached greater trochanter after LFTA for hip disorders with an our short experience of this subject. Previous information on this subject is scanty. Charnley mentioned on his paper of the long time result of LFTA of the hip for non-union of the great trochanter was reported in 4.2% of 379 hips followed for a minium of four years. Of these, a quarter went on to separation of the bony fragment. With his report, wire breakage occured in 28 cases in the presence of a united trochanter, a phenmenon which results from loops of the wire passing through soft tissues, out side the bone, and becoming fatigued by repeated bending movements. However, he pointed that the clinical result does not seems to be impaired althrough such patients occasionally complain of a feeling of insecurity when weight bearing. Among our series, two cases of non-union of the greater trochanter, after LFTA, is reported. Those of two patient were bilateral hip disorders who has indicated both hip total hip replacement. But we have done only one hip each because of inevitable patients physical conditions during the surgery. Presumably, the principal cause of non-union appeared to be excessive force on the operated one hip. The type of internal fixation for reattachment of the greater trochanter was investigated, six types which we used in this series, two separate knots for security of wire breakage after Bechtol resulted satisfactory union of the detached greater trochanter. A case of detached trochanter for revision which we used original Charnley technique with additional figure of eight wire fixation for re-enforcement. Eventually, we agree that advantage of bilateral total hip replacement at the same operative session.
Arthroplasty, Replacement, Hip ; Femur ; Friction ; Hip ; Humans ; Torque ; Weight-Bearing

No abstract available.

To determine the prevalence and risk factors of hypertension we performed cross-sectional study in a rural area. We measured BP and body mass index(BMI), and interviewed adult residents over 30-year-old age. 337 males and 357 females participated the survey. BP was checked twice and the mean was used to determine age and sex specific mean BP and prevalence of hypertension. Prevalence of definite hypertension(BP>or=160/95 or on medication) was 14. 0% in males and 17. 7% in females. Risk factor for hypertension was analysed by multiple logistic regression; age (10years: OR=l. 7) and BMI(1 BMI unit: OR=l. 2) were positively associated with hypertension but smoking(1 pack year: OR=0.9) was shown to have inverse relationship.
Adult* ; Cross-Sectional Studies ; Female ; Humans ; Hypertension* ; Logistic Models ; Male ; Prevalence* ; Risk Factors

BACKGROUND: For the treatment of generalized vitiligo patients with oral PUVA, we can use two different methods; one is to treat the lesions while the whole body is exposed. Another one is to treat the lesions while only the lesions are exposed. PURPOSE: This study was performed to determine whether lesional and whole body exposure in oral PUVA for generalized vitiligo show any therapeutic differences in effectiveness. METHODS: The vitiligo lesions were distributed over the whole body skin of the subjects and the lesion area was less than 6% of the whole skin area. PUVA was done to the subjects more than 20 times after oral administration of psoralen. The patients were classified into two different groups. One is the lesional exposure group in which the patient exposed only the vitiligo lesion. The other is the whole body exposure group in which the patient exposed almost their whole body. RESULTS: Our results show that there is no statistical difference of the therapeutic effectiveness between the two methods. CONCLUSIONS: We recommend lesional treatment rather than whole body treatment to prevent the oral PUVA side effects.
Administration, Oral ; Ficusin ; Humans ; Skin ; Vitiligo*

No abstract available.
Mortality* ; Nephrotic Syndrome*

Primary hepatic carcinoid tumors are extremely rare although the liver is a frequent site of metastases from intestinal carcinoids. Recently we investigated a case of primary hepatic atypical carcinoid in a 47-year-old man who had infested with Clonorchis sinensis for 20 years. The resected right lobe of the liver was almost completely occupied by a huge tumor, measuring 20 x 19 x 12 cm. The cut surfaces of the mass were solid, soft and pale yellow, accompanied by several small satellite nodules, measuring up to 1.5 cm in diameter. Microscopically, the tumor consisted of polygonal to columnar cells with eosinophilic granular cytoplasm forming Lym-numerous small acini and large trabeculae. Their nuclei were round to polygonal with coarse stone chromatin, had obscure to small nucleoli and frequent mitoses. There were multiple necrotic foci of varing sizes. The surrounding dilated bile ducts contained several degenerating worms on in of Clonorchis sinensis. The tumor cells were argyrophil-positive but argentaffin-negative. Immunohistochemically, the tumor cells were positive for cytokeratin, chromogranin and somatostatin but were negative for CEA, AFP, insulin, glucagon, ACTH, growth hormone and volve-prolactin. Ultrastructually, the tumor cells contained variable-sized numerous electron dense of neurosecretory granules.
Male ; Humans ; Neoplasm Metastasis