Ann Acad Med Singap
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The prevalence of recreational drug abuse among young adults, including women, has increased markedly over the last 2 decades. Nearly 90 % of these women are of childbearing age. Marijuana remains the drug most commonly used for recreational purposes in pregnancy. However, there appears to be an absence of uniform guidelines for obstetric and anaesthetic management of pregnant patients with a history of marijuana abuse. ⋯ In the absence of uniform anaesthetic guidelines for pregnant patients with a history of drug abuse, including abuse of marijuana, the decision regarding administration of peripartum analgesia or anaesthesia should be individualised and conducted on a case-by-case basis.
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Ann Acad Med Singap · May 2004
Case ReportsPlantar dislocation of lateral tarsometatarsal joint: a case of subtle Lisfranc injury.
We present a rare case of plantar dislocation of the cuboid, fourth and fifth metatarsal joints. Fracture-dislocation in the midfoot region may be subtle and difficult to recognise at the emergency department. ⋯ This case was unusual in that there was lateral tarsometatarsal disruption with neither diastasis between the first and second metatarsals nor injury to either the first or second tarsometatarsal joints. The plantar direction of dislocation was also unusual as these injuries are usually dorsal.
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Molecular adsorbent recirculating system (MARS) for albumin liver dialysis has been used as a bridge to liver transplantation in patients with fulminant hepatic failure (FHF). This review examines the available data on its clinical use, its technical aspects and present gaps in knowledge. ⋯ MARS is an effective and, thus far, safe homeostatic tool in treating FHF. More studies are needed to delineate its role as a homeostatic tool in less severe forms of ALF, including that which occurs in multi-organ failure and in AoCLF. Other studies need to focus on the optimal timing of initiation of and intensity of MARS albumin liver dialysis. The larger issue is to compare MARS with bio-assist liver devices in treating the whole spectrum of ALF.
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Focal ossification of the ligamentum flavum (OLF) is a rare cause of thoracic myelopathy. The lower thoracic spine is most frequently affected and the patients present initially with posterior column disturbances followed by progressively increasing spastic paraparesis. The pathogenesis of OLF has not been conclusively established. ⋯ OLF can significantly contribute to a spatial reduction of the thoracic spinal canal, resulting in slowly progressive paraparesis or acute paraplegia after trauma to the back. The T2-weighted sagittal image of MR imaging is the modality of choice for screening the longitudinal extent of OLF, with increased diagnostic accuracy when combined with computed tomographic myelogram. Neurological improvement usually occurs following decompression laminectomy with or without excision of the OLF. However, the persistence of residual numbness or weakness at follow-up may be due to irreversible changes within the cord as a result of severe thecal compression and the delay between the onset of initial symptoms/signs and surgical decompression. Prognosis remains poor for acute myelopathy with pre-existing OLF, despite surgery.