Singap Med J
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Case Reports
Continuous spinal analgesia--initial experiences with differential sensory block and labour pain relief.
This report describes the use of microcatheters to provide continuous spinal analgesia for the relief of labour pain. Bupivacaine 0.025% was administered through a 28G spinal microcatheter resulting in a differential block which provided effective labour pain relief. Conduction by the smaller pain fibres from the uterus were blocked, while relatively sparing the larger A fibres. ⋯ No patient had hypotension (blood pressure fall greater than 20%). However one patient suffered a severe post-dural puncture headache which required an epidural blood patch. Continuous intra-thecal spinal analgesia is a potential alternative to continuous epidural analgesia in the relief of labour pain.
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Comparative Study
Burns mass disasters in Singapore--a three decade review with implications for future planning.
The main objective of this paper is to review three decades (1962-1991) of data relating to burns mass disasters in Singapore. ⋯ The recommendation is to plan and reorganise burn treatment facilities. This is to cope with existing pattern, frequency and projected patterns of burn mass disasters which have occurred in other highly urbanised and populated countries.
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Mobile right atrial thrombus is a rare echocardiographic diagnosis with important implications on further management. We report a case of 50-year-old woman with deep vein thrombosis of her left lower limb, who was found to have a large mobile serpiginous right atrial thrombus on both two-dimensional echocardiography (2DE) and transoesophageal echocardiography (TEE). ⋯ This case demonstrates the usefulness of echocardiography as a non-invasive tool in the investigation of suspected pulmonary thromboembolism. The detection of right atrial thrombus mandates serious consideration for prompt surgical action.
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A retrospective review of fifteen patients with Grade III open ankle fractures, admitted to the Singapore General Hospital from January 1980 to December 1990 was done. Nine of the patients were males with a mean age of 47 years. Road traffic and industrial accidents accounted for 12 of the cases. ⋯ Superficial infection was found in three cases and deep infection involving the bone and joint was present in three. Range of motion at one year was satisfactory in eleven but poor in two. Seven patients developed osteoarthritis of the ankle and three had ankle arthrodesis for pain and instability.