Ann Acad Med Singap
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Vaginismus is a condition of involuntary spasm of the muscles surrounding the outer third of the vagina that is brought about by real, imagined or anticipated attempts at vaginal penetration and often leads to non-consummation of marriage. It is a classic psychosomatic disorder where phobia of vaginal penetration often stems from sexual ignorance, previous traumatic experiences or religious orthodoxy. Management of vaginismus aims at helping the woman to regain voluntary control of her pelvic floor muscles. ⋯ Management of these conditions requires a warm, empathetic attitude and demands great patience and understanding on the part of the physician. Between 1985 and 1991, 19 patients with vaginismus were treated at the National University Hospital, with a rapid desensitization programme using vaginal moulds. All 19 women could achieve satisfactory vaginal intercourse within 2 to 6 weeks of commencement of therapy.
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There have been impressive advances made over the last decade in the management of sexually transmitted viral diseases, especially in the development of effective antiviral agents. Acyclovir, first synthesized in 1974, has proved to be an effective and safe drug for the treatment of primary and frequently recurring genital herpes, according to the various medical publications over the last 10 years. This article reviews the use of acyclovir in the treatment of genital herpes and discusses the potential problem of acyclovir resistance. It also discusses two newer antiherpes drugs, famciclovir and valaciclovir, and the preliminary results of studies on their efficacy in the treatment of genital herpes.
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From May 1986 to December 1992, we performed 36 major limb replantations in 35 patients; 30 were complete and 6 were incomplete amputations. Twenty-eight of these patients were male. Their ages ranged from 5 to 81 years, the average being 22 years. ⋯ The functional result was evaluated in 30 patients, one with bilateral hemihand. Most patients regained useful hand function, with 20 achieving a grade I functional result--an ability to resume original work--or grade II functional result--an ability to do some gainful work--according to Chen's criteria. The best functional results were obtained in injuries which were near the wrist joint.
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Ann Acad Med Singap · Jul 1995
Postoperative continuous interscalene brachial plexus blockade for hand surgery.
Interscalene brachial plexus blockade is a well-established means of providing analgesia and anesthesia for upper extremity surgery. Extension into the postoperative period with continuous infusions of 0.25% bupivacaine provides several added advantages. Our survey over two years covered 126 patients undergoing surgery by the Department of Hand Surgery of our hospital. ⋯ The insertion complication rate was 11.1%; all these cases were attributed to the bolus dose given and resolved over the next few hours. Eighteen (14.3%) of the patients developed complications while on continuous infusion, the most frequent being catheter dislodgement and pain at the insertion site. In all we found this method of providing postoperative analgesia to be effective, inexpensive and easy to implement in our large hospital setting.
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Ann Acad Med Singap · Jul 1995
Common genital dermatoses in male patients attending a public sexually transmitted disease clinic in Singapore.
The male genitalia is a common site of various dermatoses. Male patients attending a sexually transmitted disease (STD) clinic may present with dermatoses that are not due to sexually transmitted diseases. ⋯ Most of the anatomical variants were incidental findings whereas most patients with the pathological dermatoses presented with these lesions. Unfamiliarity with these dermatoses may cause unnecessary anxiety to the patient and physician, resulting in inappropriate treatment.