Ann Acad Med Singap
-
Ann Acad Med Singap · Jul 1997
Case ReportsPopliteal artery aneurysm: two case reports of acute lower limb ischaemia.
Two cases of thrombosed popliteal artery aneurysm causing acute ischaemia were described. This report emphasises the importance of early diagnosis and surgical intervention of this condition. We then present a brief review of clinical presentation and current management of popliteal artery aneurysm. ⋯ Failure to recognise this limb-threatening condition can lead to delay in treatment and even limb loss. It is therefore important to increase awareness of this condition. Popliteal artery aneurysm warrants early surgical intervention, even in an asymptomatic stage because of its potential for serious complications.
-
Ann Acad Med Singap · Jul 1997
Randomized Controlled Trial Comparative Study Clinical TrialPreoperative versus postoperative pethidine for extraction of impacted third molars.
We have studied the pre-emptive analgesic effects of pethidine by comparing its analgesic effects given before or immediately after operation in a randomized, double-blind study of 40 patients undergoing removal of bilateral impacted third molars under general anaesthesia. Group 1 patients received pethidine 50 mg as a 1 ml injection 1 to 2 hours before operation and normal saline 1 ml intramuscularly immediately after surgery. Group 2 patients received normal saline 1 ml intramuscularly before operation and pethidine 50 mg as a 1 ml injection immediately after surgery. ⋯ Four patients in group 1 compared to 8 in group 2 required postoperative pethidine but this was not statistically significant. The VAS scores, time to first postoperative pethidine injection and total dose of pethidine also did not differ significantly between the 2 groups. We concluded that preoperative administration of pethidine intramuscularly did not confer additional analgesic effects compared with a similar dose given after surgery.
-
Ann Acad Med Singap · Jul 1997
Comparative StudyPenetrating keratoplasty in the Singapore National Eye Centre and donor cornea acquisition in the Singapore Eye Bank.
We analyzed all penetrating keratoplasties performed in the Singapore National Eye Centre from 1 January 1991 to 31 December 1995, using records of the Singapore Eye Bank Registry, evaluating the indications, complications, causes of graft failure, visual outcome and graft survival rate. We also looked into donor cornea acquisition in the Singapore Eye Bank and its influence on the development of corneal transplantation in the Singapore National Eye Centre. A total of 327 penetrating keratoplasties were performed during the 5-year period. ⋯ Donor corneas for the penetrating keratoplasties were obtained from foreign eye banks as well as locally, with the local donation rate steadily increasing from 1991 to 1996, with the establishment of proper eye banking facilities and the Singapore Eye Bank. These results show that the indications and outcome of penetrating keratoplasty in the Singapore National Eye Centre are similar and comparable to that of other centres with established corneal grafting programmes. The establishment of the Singapore Eye Bank has ensured the proper co-ordination of acquisition of donor material which has been vital to the development of corneal transplantation in the Singapore National Eye Centre.
-
Ann Acad Med Singap · Jul 1997
Preoperative prediction of intra and postoperative red blood cell transfusion in surgical patients.
Anaesthetists were asked to predict the need for intra and postoperative red blood cell transfusion in 1706 patients before surgery. Each prediction was made using only the individual patient's medical history and physical examination, the results of routine preoperative laboratory investigations, and knowledge of the proposed surgical procedure. ⋯ Using a stepwise logistic regression model, preoperative haemoglobin concentration, Surgical Table of the procedure, and age of patients were found to significantly determine the need for intra and postoperative red blood cell transfusion. It is recommended that type and screen should replace group and crossmatch procedures in surgical patients where no intra and postoperative red blood cell transfusion is predicted as necessary.
-
Ann Acad Med Singap · Jul 1997
ReviewJoint lectureship of the Royal College of Surgeons of Edinburgh and the Academy of Medicine, Singapore--accurate long-term documentation in surgical audit and evaluation of outcomes.
The purpose of a surgical audit is to allow a critical assessment of patient care, carried out among peers and in an atmosphere of learning, open discussion, free of recriminations. The results of a surgical unit will hopefully lead to improvement in the quality of care of our patients by reducing the preventable causes of mortality and morbidity. Data from surgical audit can also be used to monitor the teaching programme in a department. It may even allow us to study the cost effectiveness of certain procedures which is obviously very important in this era of diminishing resources and cost containment.