Singap Med J
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The first anaesthesia-based acute pain service in Singapore is described. The benefits, risks and resource implications of such a service during its first two years are reviewed. ⋯ There were no reports of respiratory depression in the patient-controlled analgesia group. The authors conclude that the provision of an acute pain service in the local context was safe and resulted in excellent post-operative patient satisfaction.
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A 91-year-old Chinese man developed bilateral lower limb oedema due to venous obstruction resulting from a distended urinary bladder. After the bladder was decompressed by urethral catheterisation, the bilateral lower limb oedema promptly subsided. Although a distended urinary bladder is a rare cause of bilateral lower limb oedema, it can be easily recognised by palpation of the lower abdomen and the relief of symptoms by urethral catheterisation is most rewarding.
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Review Case Reports
Renocolic fistula as a complication to xanthogranulomatous pyelonephritis.
Four patients with xanthogranulomatous pyelonephritis were found to have renocolic fistulae. Coincidentally, the left kidney was involved in all four cases. All patients presented with renal mass. ⋯ In none of the patients was the renal condition confidently diagnosed preoperatively, nor was the colonic fistula suspected. In all four patients, nephrectomy was performed together with resection of the involved colon followed by a satisfactory recovery. The possibility of a colonic fistula should be kept in mind as a complication to this rare renal condition in spite of the absence of colonic symptoms and normal finding in barium enema studies.
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A patient was admitted with an impacted foreign body in the oesophagus. Repeated attempts to remove it during oesophagoscopy proved difficult and caused obstruction of the trachea during manipulation of the foreign body. A smaller endotracheal tube was subsequently placed in the trachea relieving the obstruction.