Ann Acad Med Singap
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Ann Acad Med Singap · Nov 2007
The role of electrophysiology in the diagnosis and management of cervical spondylotic myelopathy.
Cervical spondylotic myelopathy (CSM) is managed by conservative or surgical measures. While surgery is often performed in cases of longstanding or severe CSM, there is a lack of evidence concerning its efficacy. Transcranial magnetic stimulation (TMS) is a quick, safe, painless and non-invasive technique to study conduction in the descending corticospinal pathways in the spinal cord. The conduction time from the motor cortex to the anterior horn cell [central motor conduction time (CMCT)] is a measure of the integrity of corticospinal pathways. We have previously established the role of TMS in diagnosis and screening of CSM. In this study, we further investigate the use MEPs obtained with TMS in the outcome prediction of severe CSM patients requiring operative intervention. ⋯ In early CSM, lateral corticospinal tracts are first to be affected. It is thus possible that UL CMCT abnormality reflect more severe affectation of the corticospinal tracts placed relatively more medially in the cervical cord. Surgical intervention may have then effectively relieved the clinically significant compression, leading to a better outcome. This was further corroborated by our finding of negative correlation of S1 with UL CMCT, suggesting that patients who were clinically more severe were also electrophysiologically more abnormal, and subsequently benefited more from surgical decompression relative to patients with normal UL CMCT. This the largest series, to our knowledge, showing for the first time that UL CMCT abnormality obtained with TMS is an independent predictor of good surgical outcome in severe CSM.
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Ann Acad Med Singap · Oct 2007
Comparative StudyIntramedullary fixation of subtrochanteric fractures with long proximal femoral nail or long gamma nail: technical notes and preliminary results.
The objective of this study was to prospectively evaluate the clinical outcome of traumatic subtrochanteric fractures fixed with long proximal femoral nail (PFN) or long gamma nail with particular emphasis on our experience of surgical techniques. ⋯ This study suggests that long PFN or long gamma nail is a reliable implant for subtrochanteric fractures, leading to high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the operation is technically demanding. Gradual learning and great patience is needed in order to make this method truly minimally invasive.
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Ann Acad Med Singap · Oct 2007
Case ReportsPeripartum acute anterior ST segment elevation myocardial infarction: an uncommon presentation of acute aortic dissection.
Atherosclerotic coronary artery thrombosis is the most common cause of acute myocardial infarction. ⋯ A high index of clinical suspicion is required in acute myocardial infarction presenting without traditional cardiovascular risk factors.
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Ann Acad Med Singap · Sep 2007
Multicenter StudyFrom a "generalist" medical graduate to a "specialty" resident: can an entry-level assessment facilitate the transition? assessing the preparedness level of new surgical trainees.
Concerns have been raised in the literature about how well the undergraduate curriculum prepares medical students for residency. An assessment was designed and administered to entering postgraduate residents in surgery to test their preparedness vis-a-vis the competence level expected of them at the beginning of their training. This paper explores the role and place of such an assessment in the medical education continuum. ⋯ This pilot study reveals definite educational gaps in both knowledge and skills among the residents studied. Such an intervention can be very informative, providing immense educational benefit to the learner, faculty and programme, and has an important place in the continuum of medical training.
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Ann Acad Med Singap · Jun 2007
Mutation screening in KCNQ1, HERG, KCNE1, KCNE2 and SCN5A genes in a long QT syndrome family.
Long QT syndrome (LQTS), an inherited cardiac arrhythmia, is a disorder of ventricular repolarisation characterised by electrocardiographic abnormalities and the onset of torsades de pointes leading to syncope and sudden death. Genetic polymorphisms in 5 well-characterised cardiac ion channel genes have been identified to be responsible for the disorder. The aim of this study is to identify disease-causing mutations in these candidate genes in a LQTS family. ⋯ We did not identify any clear identifiable genetic marker causative of LQTS, suggesting the existence of LQTS-associated genes awaiting discovery.