Singap Med J
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Case Reports
Cholestasis and biliary dilatation associated with chronic ketamine abuse: a case series.
Ketamine is a dissociative anaesthetic agent that is still widely used in veterinary and human medicine. It is increasingly being used as a recreational hallucinogenic drug. ⋯ We report three cases of chronic ketamine misuse in three young men who all presented with obstructive jaundice and biliary tract abnormality. We also describe the clinical features, radiological findings and potential underlying mechanisms for this new entity.
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We aimed to identify the variables associated with ovarian hyperstimulation in Asian patients and compare them with western standards. ⋯ Gonadotropin doses at stimulation should start at 150 iu or less in women below 35 years of age, with a step up of 37.5 iu, as necessary. Transfer should be abandoned in the presence of high oestradiol levels (more than 5,000 pg/ml), when the total number of intermediate and large follicle count exceeds 30 on the day of oocyte retrieval, or when more than 19 eggs are retrieved. Variables in the Asian population appear to be similar to those in the western population.
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Effort thrombosis of the upper extremity is secondary to thrombosis of the axillary and/or subclavian veins that develop from heavy arm exertion. This case illustrates venous thrombosis of the right brachiocephalic vein in a 32-year-old man who presented with a cyst-like swelling in the right neck with no associated pain or trauma. ⋯ In this study, we highlight the importance of early investigation and treatment of symptomatic athletes so that long-term disability can be prevented. This study also shows the timely use of computed tomography imaging, which can help to identify the syndrome in previously undiagnosed patients.
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Higher-order multiple births have implications for perinatal and maternal morbidity and mortality. This study aimed to determine the incidence and outcomes of higher-order multiple pregnancies in a rural area in Southeast Nigeria. ⋯ The Igbo women of Ebonyi State, Nigeria, have a high rate of higher-order multiple births. These are attended by increased obstetric and perinatal complications. Abdominal delivery is therefore recommended in order to reduce the rate of intrapartum stillbirth and birth asphyxia among triplets.