Ann Acad Med Singap
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Ann Acad Med Singap · May 2007
Awake craniotomy under local anaesthesia and monitored conscious sedation for resection of brain tumours in eloquent cortex--outcomes in 20 patients.
Resection or even biopsy of an intra-axial mass lesion in close relationship to eloquent cortex carries a major risk of neurological deficit. We review the safety and effectiveness of craniotomy under local anaesthesia and monitored conscious sedation for resection of mass lesions involving eloquent cortex. ⋯ Tumour surgery with conscious sedation in combination with frameless computer stereotactic guidance is a safe technique that allows maximal resection of lesions in close relationship to eloquent cortex and has a low risk of neurological deficit.
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Awake craniotomy allows accurate localisation of the eloquent brain, which is crucial during brain tumour resection in order to minimise risk of neurologic injury. The role of the anaesthesiologist is to provide adequate analgesia and sedation while maintaining ventilation and haemodynamic stability in an awake patient who needs to be cooperative during neurological testing. We reviewed the anaesthetic management of patients undergoing an awake craniotomy procedure. ⋯ Awake craniotomy for brain tumour excision can be successfully performed under good anaesthetic conditions with careful titration of sedation. Our series showed it to be a well-tolerated procedure with a low rate of complications. The benefits of maximal tumour excision can be achieved, leading to potentially better patient outcome.
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Ann Acad Med Singap · Apr 2007
Review Case ReportsLessons learnt from two women with morbidly adherent placentas and a review of literature.
Pathologically adherent placentas occur when there is a defect of the decidua basalis, typically arising from previous caesarean section, resulting in abnormally invasive implantation of the placenta. The depth of placental invasion varies from the superficial (accreta), to transmural and possibly beyond (percreta). ⋯ Management relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery.
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Ann Acad Med Singap · Mar 2007
Violence-related behaviours among Malaysian adolescents: a cross sectional survey among secondary school students in Negeri Sembilan.
The aim of this study was to determine the prevalence of violence-related behaviours among adolescents and the factors associated with it. ⋯ Violence-related behaviours among adolescents, especially involvement in physical fights, are common and are positively associated with certain factors such as smoking, taking drugs, playing truant, feeling sad or hopeless. Interventions designed at targeting adolescent violence should also address these factors and target the high-risk groups. There may be a need to identify and provide services for adolescents who exhibit these factors.