Singap Med J
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Venography is often requested to confirm the clinical suspicion of deep vein thrombosis (DVT) in patients with calf pain or swelling. Often, no clots could be demonstrated and the patients are discharged without a confirmed diagnosis. It is now being increasingly recognised that a Baker's (popliteal) cyst, ruptured or otherwise, may simulate deep vein thrombosis. ⋯ Baker's cysts were confirmed on subsequent knee arthrograms, ultrasonography or magnetic resonance imaging (MRI). It is emphasised here that a failure to demonstrate DVT in a patient with signs and symptoms, of DVT should prompt a search for Baker's cyst. The pathological anatomy of Baker's cyst is briefly reviewed with the aid of magnetic resonance images.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral premedications in paediatric day surgery.
The degree of sedation in 191 day-stay children after oral premedication were compared. One hundred and forty-six were 1-5 years old (Group 1) and were randomised to receive either chloral 40 mg/kg, midazolam 0.2 mg/kg, promethazine 1 mg/kg, trimeprazine 3 mg/kg or placebo. Forty-five were 5-12 years old and were randomised to receive either trimeprazine 3 mg/kg, midazolam 0.2 mg/kg or placebo (Group 2). ⋯ They were assessed on leaving the ward, at separation from the parents, at induction, in the recovery room and one and two hours after returning to the ward. In Group 1, it was found that chloral and trimeprazine gave the best degree of sedation but the sedative effect of trimeprazine lasted longer into the post operative period. In Group 2, it was found that the children did not require deep sedation and the anxiolysis obtained with midazolam was adequate.
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We report a case of cervicofacial actinomycosis with paravertebral extension in a 60-year-old man who presented with recurrent neck masses. Diagnosis was confirmed on culture and histology of pus and debris obtained from surgical drainage. He improved only after lengthy in-hospital high dose penicillin therapy. He is currently well and is on maintenance doxycycline therapy for 6 months following the high dose penicillin therapy.
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Clinical Trial
Combination chemotherapy (dacarbazine, carmustine, cisplastin, and tamoxifen) in advanced melanoma.
Melanoma is rare in Singapore with an age-standardised rate (ASR) of 0.4-0.8 per 100,000 per year. Thirteen patients with metastatic or locally advanced melanoma were referred to the Department of Medical Oncology, Singapore General Hospital between Feb 1991 and Nov 1993. Ten patients were given combination chemotherapy comprising carmustine (BCNU), cisplatin, dacarbazine (DTIC) and tamoxifen. ⋯ Two patients experienced delays of their subsequent cycles of treatment by 1-2 weeks due either to neutropenia and/or thrombocytopenia. This regimen is a fairly active combination against metastatic melanoma, particularly those with metastases to the nodes, skin and the lung. Those with involvement of other sites tend to respond poorly.
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Hepatitis B serological markers were investigated in 1,132 consecutive Singaporean HBV carriers. Hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were found concurrently in 234 carriers (234/1132 or 21%). ⋯ There were no difference in HBeAg positive status, as well as HBV-DNA positive status in concurrent HBsAg/anti-HBs carriers compared to carriers without anti-HBs. Our results suggested that concurrent HBsAg and anti-HBs is a common serologic pattern in Singaporean HBV carriers.