Singap Med J
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The place of laparoscopic appendicectomy in the management of complicated appendicitis remains unsettled with reports of a higher incidence of postoperative intraperitoneal abscess. Most studies on laparoscopic appendicectomy in children have been done in the Western population. This retrospective review was done to compare laparoscopic appendicectomy with open appendicectomy in children with complicated appendicitis in a hospital in Malaysia. ⋯ This review has confirmed that the longer the operating time, the lower the incidence of wound infection and the shorter the postoperative stay for laparascopic appendicectomy. There was no increased risk of postoperative intraperitoneal abscess.
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A 31-year-old man with a penetrating chest injury presented acutely with pulseless electrical activity, as a result of a ventricular laceration causing pericardial tamponade. Emergency department thoracotomy was performed to release the tamponade and he was operated on immediately to repair the laceration. He subsequently survived and was discharged to a community hospital for rehabilitation. We present this case of penetrating cardiac injury in which the patient arrived in extremis and for which emergency department thoracotomy was performed, and we discuss the role of emergency thoracotomy, its indications and outcome indicators.
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Spontaneous spinal epidural haematoma (SSEH) is rare. No identifiable cause is found in the majority of cases, while anticoagulation accounts for up to 17 percent of cases. Aspirin-associated SSEH, however, has rarely been described in literature. ⋯ Our patient recovered well and regained full motor and sensory function. Aspirin is unlikely to be the direct cause of SSEH but may predispose to it, with the underlying cause being a locus minoris resistentiae, consisting of a network of weakened epidural veins. Early diagnosis and treatment are essential for a successful outcome.
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Beta-thalassaemia major is an autosomal recessive disorder that results in severe microcytic, hypochromic, haemolytic anaemia among affected patients. Beta-thalassaemia has emerged as one of the most common public health problems in Malaysia, particularly among Malaysian Chinese and Malays. This study aimed to observe the spectrum of mutations found in Kelantan Malay beta-thalassaemia major patients who attended the Paediatrics Daycare Unit, Hospital Universiti Sains Malaysia, Kelantan, Malaysia, the data of which was being used in establishing the prenatal diagnosis in this Human Genome Centre. ⋯ Our results added to the existing data on the common beta-globin gene defects in Kelantan Malay beta-thalassaemia patients.
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The management of postoperative pain is an increasingly important aspect of healthcare, leading to the establishment of acute pain services in major surgical centres worldwide. The acute pain service (APS) was established in most Singapore hospitals in the 1990s. We analysed data collected in our institution over a ten-year period (1998-2007), documenting our experiences, outcomes and complications encountered by our APS. ⋯ The move away from invasive and less targeted analgesic modalities has not compromised the quality of analgesia provided. Major morbidity remains extremely rare and incidence of complications has been reduced over the years. Patient satisfaction remains well in excess of 90 percent, and the side effects are largely well controlled. With further advancements in the provision of acute postoperative analgesia, the APS will continue to play an important role in the holistic convalescence of the surgical patient.