Ann Acad Med Singap
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Multicompartmental blocks are commonly described in epidurals but not spinals. We describe a case of subarachnoid block performed in an obese patient which resulted in a clinical presentation resembling that of a subdural block. ⋯ The diagnosis of subdural block must be considered in patients with unusual presentations after a spinal anaesthetic. Factors affecting spread of hyperbaric bupivacaine are also highlighted.
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Ann Acad Med Singap · May 2002
Comparative StudyAre maternal deaths on the ascent in Singapore? A review of maternal mortality as reflected by coronial casework from 1990 to 1999.
In Singapore, published maternal mortality rates (MMR) over the last decade (1990 to 1999) have been so low (0.0 to 1.0 per 1000 live births and still births) as to imply that maternal deaths are rare to the point of being non-existent in some years. This inference is counterintuitive, and earlier studies on maternal mortality, amniotic fluid embolism (AFE) and pulmonary thromboembolism (PTE) have also suggested otherwise. Accordingly, local trends in maternal mortality warrant further examination. ⋯ This was an upward trend in MMR, as reflected in coronial casework, over the last decade. It would appear that the local, estimated (direct and indirect) maternal mortality prevalence compares favourably with the MMR reported in developed countries. The apparent rate of AFE was no less than 4 times higher than that reported in the United Kingdom, while the maternal mortality rate from PTE was at least as high. Allowing for the possibility that such deaths were under-reported, the actual annual MMR and 10-year prevalence could be appreciably higher than the estimates presented here. There may well be a case for the establishment of a comprehensive database of maternal deaths, that is updated continually and contemporaneously, in Singapore.
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Thrombophilia refers to disorders which are associated with a persistent hypercoagulable state and a tendency towards thrombosis. They may be inherited, acquired or complex, when genetic factors interact with environmental influences. The objective was to review the various inherited thrombophilias and the antiphospholipid syndrome in relation to pregnancy-related venous thromboembolism and other obstetric complications. ⋯ Venous thromboembolism is now recognised as a multicausal and multigenic condition. This is particularly evident in pregnancy where multiple risk factors interact and are often identified in women who develop venous thrombosis. With the discovery of factor V Leiden and the prothrombin gene G20210A mutation, inherited thrombophilia can now be detected in a significant proportion of Caucasians who develop venous thromboembolism; however, both these mutations are rarely found in Asians. Identifying women at risk for venous thromboembolism and instituting thromboprophylaxis appropriate to the level of risk remains the key to reducing morbidity and mortality from the condition. Additional research into the intensity, type and duration of thromboprophylaxis for different levels of risk are required. The role of inherited thrombophilia in the pathogenesis of obstetric complications needs to be further defined before screening can be recommended for indications other than venous thromboembolism.
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Ann Acad Med Singap · May 2002
Comparative Study Clinical TrialPreliminary experience in radionuclide therapy of hepatocellular carcinoma using hepatic intra-arterial radio-conjugates.
In a minority of the cases, resection of hepatocellular carcinoma (HCC) is potentially curative but local recurrence is common. Adjuvant intra-arterial radio-conjugate therapy could potentially reduce the rate of local recurrence and increase disease-free and overall survival. However, in the majority of cases, treatment of HCC is largely palliative. A wide range of palliative treatment options are available and these include external radiation, hepatic intra-arterial chemo-embolisation, systemic chemotherapy and percutaneous ethanol injection. The long-term survival rate is poor. Hepatic intra-arterial radio-conjugate therapy provides a new and promising means of palliation. ⋯ Our results in the adjuvant treatment of patients with I131 lipiodol following curative resection of early HCC and in the palliative treatment of unresectable HCC using Y90 microspheres and Re188 lipiodol are preliminary and not fully conclusive. These preliminary results have to be confirmed in larger groups of patients and by prospective, randomised, controlled trials. This study highlights the preliminary experience in radionuclide therapy of HCC using hepatic intra-arterial radio-conjugates in a local context.
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Ann Acad Med Singap · May 2002
The acute presentation of pulmonary thromboembolism: a retrospective viewpoint.
Acute pulmonary thromboembolism (PE) has been considered rare among Asians. We aim to describe the frequency and clinical features of this condition in a hospital in Singapore. Among patients admitted by the Emergency Department (ED), comparisons were made between those primarily diagnosed in the ED and those who were not. ⋯ Acute PE is not as rare here as previously thought. Clinical features reveal more similarities than differences compared to other studies in the literature. We advocate a high index of suspicion for earlier diagnosis in the ED.