Singap Med J
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A 35-year-old Chinese man presented with acute thyrotoxic periodic paralysis complicated by near-fatal cardiac arrhythmias due to persistent hypokalaemia, despite maximum potassium supplementation. He was eventually resuscitated with external cadioversion. In this unusual case of severe refractory hypokalaemia leading to ventricular fibrillation in a patient with underlying thyrotoxicosis, the potential dangers concerning the use of dextrose infusion and beta-adrenergic agent for resuscitation are highlighted.
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Case Reports
Acute cauda equina syndrome secondary to free fat graft following spinal decompression.
A 63-year-old man developed acute cauda equina syndrome due to fat graft compression. Following decompressive laminectomy and posterior instrumented fusion with pedicle screw fixation for spinal stenosis of L5 and S1 vertebral levels, free fat grafting was performed to cover the exposed dura. ⋯ Intraoperatively, significant dural compression by the fat graft was confirmed. Immediate removal of the fat graft resulted in recovery from cauda equina syndrome.
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Surgical resection is not feasible in most cases of malignant mesothelioma and palliation of symptoms remains the mainstay of treatment. When a pleural effusion is loculated, the standard treatment methods of intercostal tube drainage and pleurodesis may not be helpful. ⋯ It was successful in breaking the locules and draining the effusion. Intrapleural fibrinolysis should be considered in cases of loculated pleural effusion due to malignant mesothelioma, as it may provide symptom relief and palliation.
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Fasting during the month of Ramadan is compulsory in the Muslim faith. Although pregnant women may be exempted, many still choose to fast while others are more careful in practising it. This survey examines the practice of fasting among pregnant Muslim women in Singapore based on the prevalence in relation to factors such as parity, social and economic circumstances. It also analyses the factors that influence the decision to fast and the successful completion of the fast, and examines their knowledge, belief and attitudes on fasting during the holy month of Ramadan. ⋯ Doctors and health workers need to understand the religious obligations of a Muslim towards fasting during Ramadan. Only through this can a doctor adequately counsel Muslim patients and allow informed decision with regards to fasting. With respect to pregnant women, provisions are allowed for them not to observe fasting.
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Surgical clip migration is a well-known phenomenon ever since their first use in surgery. The mechanism of clip migration is poorly understood, and can occur from days to years after laparoscopic cholecystectomy. Migration of the surgical clips may be a complex process involving necrosis, pressure exerted from intra-abdominal movement, formation of stones over the exposed clip within the bile duct, and eventual migration into the common bile duct. We report two cases, a 58-year-old man and a 54-year-old woman, of clip- induced biliary stones resulting from surgical clip migration a few years after laparoscopic cholecystectomy.