Singap Med J
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We sought to determine the epidemiological features and the headache burden of headache patients in the Singapore primary care setting. Particular attention was given to the adequacy of migraine diagnosis and management as well as the utilisation of prophylactic medication by primary care doctors. ⋯ Diagnosis of migraine is inconsistent in the primary care setting despite the condition being responsible for considerable disability. Prophylactic treatment is underutilised as a management strategy, and the risk of medication-overuse headaches is underestimated. Our results emphasise the continuing need for education of primary care physicians and the public about strategies for effective headache diagnosis and treatment.
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Severe anaesthetic anaphylaxis is relatively uncommon. Oxygen, fluids and epinephrine are considered to be the mainstay for treatment of cardiovascular collapse and current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of a cardiovascular collapse. Recently, evidence has emerged in the support of the use of vasopressin in cardiopulmonary resuscitation; it is also recommended for the treatment of ventricular fibrillation, septic shock and post-cardiopulmonary bypass distribution shock. ⋯ We report a 24-year-old woman who developed severe anaphylactic shock at induction of anaesthesia while undergoing laparoscopic cholecystectomy. Circulation shock was refractory to epinephrine and high doses of pure alpha-agonist phenylephrine and norepinephrine. Single intravenous dose of two units of vasopressin re-established normal circulation and blood pressure.
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Case Reports
Oesophageal duplication cyst: an unusual cause of retrosternal pain and dysphagia in an adult.
Oesophageal duplication cysts in adults are a rare entity and are mostly asymptomatic. We describe the imaging findings in a rare case of oesophageal duplication cyst simulating cold abscess, causing retrosternal pain and dysphagia in a 25-year-old man.
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The arthroscopic method offers a less invasive technique of Bankart repair for traumatic anterior shoulder instability. The results continue to improve with the advancements made in instrumentation and technique. This study aims to evaluate the outcome of arthroscopic Bankart repair with the use of suture anchors for cases that were followed-up for at least two years from the date of surgery. ⋯ Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method that can provide a good clinical outcome with excellent postoperative shoulder motion and low recurrence rate.