Singap Med J
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Randomized Controlled Trial
Effects of intrathecal midazolam in spinal anaesthesia: a prospective randomised case control study.
Subarachnoid block with local anaesthetics and adjuvants has been extensively used for surgery. Intrathecal midazolam produces antinociception and potentiates the effect of local anaesthetics. We compared intrathecal bupivacaine with and without midazolam to assess its effect on the duration of sensory block, motor block and pain relief. ⋯ The addition of preservative-free midazolam to bupivacaine intrathecally resulted in prolonged postoperative analgesia without increasing motor block.
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Rapunzel syndrome is a rare condition that occurs when gastric trichobezoar extends beyond the pylorus and into the bowel. Recurrent Rapunzel syndrome is an extremely rare entity, with only two cases reported in the literature so far. Here, we present a case of recurrent Rapunzel syndrome in a 15-year-old girl. ⋯ In both stances when Rapunzel syndrome was diagnosed, a tuft of hair extending from the stomach toward the jejunum was observed. The patient underwent psychiatric consultation and supervision after the first laparotomy; however, a lack of follow-up resulted in recurrence. We conclude that complete removal of trichobezoar and psychiatric consultation, coupled with long-term follow-up, are essential to prevent recurrence.
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Moyamoya disease is an uncommon progressive cerebral vasculopathy that is more frequently seen in the Asian population. It has been described sporadically in other parts of the world. Proper knowledge of the pathophysiology and institution of appropriate perioperative measures improves patient prognosis. ⋯ Epidural anaesthesia was administered using 0.5 percent bupivacaine and 50 μg fentanyl. A stable haemodynamic state was maintained using left lateral uterine displacement, intravenous crystalloids and ephedrine boluses. The patient suffered no neurological deficit and was discharged with a healthy baby four days after the surgery.
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Brodie's abscess is not a common variant of subacute osteomyelitis; however, when it does occur, the presentation is atypical and usually late. This study aimed to describe the mode of presentation of Brodie's abscess and evaluate the results of surgical treatment in a resource-poor setting. ⋯ Patients with Brodie's abscess respond well to surgical curettage of the abscess, cancellous bone grafting and antibiotic therapy.
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Case Reports
Electrocardiography Series. What is the cause of the regular wide QRS complex tachycardia?
Regular broad QRS complex tachycardias may be ventricular in origin or due to supraventricular tachycardia with aberrancy. Antidromic atrioventricular re-entrant tachycardia occurring in Wolff-Parkinson-White syndrome is a third possibility. ⋯ Ventricular tachycardia may be monomorphic or polymorphic. The management of ventricular tachycardia depends on clinical symptoms and is influenced by the presence of structural heart disease.