Ann Acad Med Singap
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Ann Acad Med Singap · Mar 1997
Review Case ReportsMonoplegia following obstetric epidural anaesthesia.
We describe a case of transitory monoplegia following obstetric epidural anaesthesia which we believe to be either due to direct trauma to the nerve roots or radicular artery spasm resulting in spinal cord ischaemia both secondary to the epidural catheter. An obstetric epidural was performed on a 34-year-old lady with no significant past medical history. Transient radicular pain down her left leg was experienced during the insertion of the catheter. ⋯ She still had left-sided numbness and weakness 9 hours after removal of the catheter, but without urinary or bowel dysfunction. A magnetic resonance imaging scan excluded any space occupying lesion. She was managed conservatively and had complete recovery 35 hours after the last dose of local anaesthetics.
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Ann Acad Med Singap · Mar 1997
A retrospective evaluation of operative treatment of ankle fractures.
Between 1990 and 1992, 89 patients with ankle fracture were treated by open reduction and internal fixation in accordance with the Arbeitsgemeinschaft für Osteosynthesefragen (AO) principles and were available for evaluation with a mean follow-up period of 3.6 years (range 3 to 5 years). According to the AO classification, there were 21 type A, 37 type B and 31 type C fractures. ⋯ Fair or poor results in 1 type A, 2 type B and 6 type C fractures. Complications included screws in the joint in 2 cases and infection in 3 cases.
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Ann Acad Med Singap · Jan 1997
ReviewHypertonic saline dextran (HSD) and intraosseous vascular access for the treatment of haemorrhagic hypotension in the far-forward combat arena.
Battlefield statistics show that 50% of deaths are due to acute haemorrhage. Hypertonic (7.5% saline)/hyperoncotic (6% Dextran-70) solution (HSD) for the treatment of haemorrhagic hypotension may have physiologic and logistic advantages over conventional fluid therapy for use in the far-forward combat arena. ⋯ Over the past 5 years we have investigated intraosseous infusion of HSD via the sternum or tibia, as a possible means of achieving rapid vascular access and plasma volume expansion. These data in experimental animals and one clinical study show that HSD can be safely and rapidly infused via the intraosseous route achieving the same haemodynamic benefit as observed with intravenous administration.
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Ann Acad Med Singap · Jan 1997
Case ReportsManagement of concomitant maxillofacial, cervical spine and laryngeal trauma--case reports.
Three cases are presented to stress important points in the diagnosis and management of concomitant maxillofacial, cervical spine and laryngeal trauma. Emergency tracheostomy to control airway, immediate rigid fixation of maxillofacial fractures, early computed tomographic (CT) scans to evaluate the extent of laryngeal and cervical spine injury and the early repair of laryngeal injury will provide better aesthetic and functional results.
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For decades, warfighters have been putting in place a sophisticated "digital battlefield", an electronic communication and information system to support advanced technology. Medicine is now in a position to leverage these technologies to produce a fundamental revolution, and the keystone is the digital physician. Today nearly all information about a patient can be acquired electronically, and with the new technologies of teleoperation and telesurgery we can provide remote treatment and even surgery through telemedicine. ⋯ Also, the expertise from any specialist will be available from the rear echelons as far back as the home country. For education and training in combat casualty care, virtual reality simulators are being implemented. This same scenario can be utilised in civilian health care, especially in providing care to patients in remote areas who do not currently have access to simple, let alone sophisticated, health care.