Ann Acad Med Singap
-
Ann Acad Med Singap · Mar 1998
Soft tissue cover in compound and complicated tibial fractures using microvascular flaps.
This is a retrospective review of the use of microvascular flaps in the salvage of severely injured lower limb. From January 1992 to December 1994, we treated 10 patients using 10 microvascular flaps; 8 patients with Type III compound tibial fractures and 2 patients with infected implants following internal fixation of comminuted tibial fractures. The size of soft tissue defect ranged from 6 x 3 cm to 20 x 10 cm. ⋯ Successful soft tissue cover facilitates secondary bone grafting procedures. Although the timing of surgery per se does not adversely affect the success rate of microvascular flaps, delayed soft tissue cover is associated with a high chronic infection rate (37.5%). An adequate surgical debridement is crucial in reducing the complication of deep infection.
-
Dislocation of the testes is an uncommon sequela of trauma. In contemporary times, it is usually associated with motorcycle accidents. We present 2 cases of unilateral traumatic testicular dislocation and 1 case of bilateral dislocation, all involving motorcyclists. ⋯ Early reduction is recommended because of histological changes seen in dislocated testes. Surgical reduction is often required. The significance of this condition must be emphasised to doctors managing trauma patients and early urological consultation obtained.
-
Ann Acad Med Singap · Jan 1998
ReviewThe appropriate use of antineutrophil cytoplasmic antibody (ANCA) testing in rheumatic diseases.
The antineutrophil cytoplasmic antibody (ANCA) test is now available in most routine diagnostic immunology laboratories. Improvement, simplification and standardisation of the testing methodology have enabled it to become more reliable and accessible to clinicians. ANCA has strong association with and is most useful in the diagnosis and management of the ANCA-associated vasculitides which include Wegener's granulomatosis, microscopic polyarteritis, Churg-Strauss syndrome and primary pauci-immune necrotising and crescentic glomerulonephritis. ⋯ The antigen-specific solid-phase assays have comparable sensitivity with IIF assays and improved specificity in some instances. However, appropriate use of the ANCA test requires full knowledge of its capabilities and limitations, and the results should always be correlated with clinical data. In particular, it is important to understand that it is not only test sensitivity and specificity, but patient selection that contributes to the positive predictive value and clinical relevance of the test result.
-
Ann Acad Med Singap · Jan 1998
Case ReportsMusculoskeletal pain clinic in Singapore--sacroiliac joint somatic dysfunction as cause of buttock pain.
Buttock pain was a predominant symptom in a series of patients seen with recalcitrant "backache" in the author's pain clinic which has a musculoskeletal emphasis. Assessment suggested the sacroiliac joint as the culprit pain generator and patients underwent confirmatory testing which included fluoroscopy-guided intra-articular injections of lignocaine and steroid along with combined therapeutic modalities of oral analgesics, physical therapy, manual medicine techniques and ergonomic assessments. Two case reports illustrate this condition which is probably under-recognised and inadequately addressed locally.
-
Scrub typhus is widely endemic in Asia. Man's behaviour and climatic changes greatly influenced the occurrence of the disease. Increasing prevalences of scrub typhus have been reported from some Asian countries and may coincide with the widespread use of beta-lactam antibiotics or to improve diagnostic facilities and/or more urbanisation into rural areas. ⋯ The complications include pneumonitis, meningoencephalitis, renal failure and jaundice. Improved serologic and molecular diagnostic tests are now available. Although drug-resistant strain of Orientia tsutsugamushi has been reported, the infection usually responds to simple but unpopular drugs such as doxycycline or chloramphenicol.