Singap Med J
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Comparative Study
Distribution of atypical fractures and cortical stress lesions in the femur: implications on pathophysiology.
Some authors have hypothesised that atypical femur fractures occur due to tensile mechanism of failure. We studied the distribution of such lesions along the femur shaft to determine if they concentrate in regions that are subject to tensile loading. ⋯ Based on previously established femoral shaft loading characteristics, atypical lesions were clustered at the region of maximal tensile loading. No lesion occurred in regions that were subject to compressive loading. This unique distribution supports a tensile mechanism of failure in such lesions.
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Case Reports
Clinics in diagnostic imaging (133). Retained placenta from an intra-abdominal pregnancy.
A 29-year-old Indonesian woman presented with abdominal pain seven months after an intra-abdominal pregnancy. Ultrasonography revealed a cystic mass in the pelvis and magnetic resonance imaging showed an umbilical stump within it, indicating a retained placenta. This was removed surgically, and on histology, an infarcted placenta was confirmed.
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Randomized Controlled Trial
Single-dose periarticular steroid infiltration for pain management in total knee arthroplasty: a prospective, double-blind, randomised controlled trial.
Post total knee replacement pain control using parenteral opioids results in significant side effects like nausea and vomiting. Periarticular injections are used to control pain without these side effects. This study aimed to evaluate the safety and efficacy of periarticular steroid injection in patients undergoing total knee arthroplasty, as well as assess the patient's functional outcomes over a period of two years. ⋯ This modality of pain control is safe and efficacious for post total knee replacement pain control.
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Case Reports
Gastric volvulus with diaphragmatic hernia presenting with unexplained weight loss: a delayed diagnosis.
Gastric volvulus (GV) is a rare condition that presents with epigastric pain, retching and at times, vomiting. There are two types of GV: organoaxial and mesenteroaxial. We report the case of a 49-year-old woman with chronic mesenteroaxial volvulus with left-sided diaphragmatic defect. ⋯ The patient was diagnosed with barium meal and contrast-enhanced computed tomography imaging. She was treated with open repair of diaphragmatic defect and anterior gastropexy. She was asymptomatic and had gained weight at the six-month follow-up.
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Intravenous (IV) metoclopramide is a frequently prescribed medication in the emergency department (ED). Extrapyramidal side effects like tardive dyskinesia are known to develop with chronic use of metoclopramide, while acute akathisia is a lesser known side effect following IV administration. Akathisia is characterised by a sensation of restlessness and distress, as well as constant, non-purposeful limb movement. ⋯ However, akathisia can be readily reversible, with a successful patient outcome if promptly diagnosed. We report a case of acute akathisia in a young female patient after IV bolus metoclopramide was administered to treat her gastroenteritis in our ED. We highlight the diagnostic process, the difficulties in the management of the primary condition resulting from her akathisia and its successful management using IV diphenhydramine and midazolam.