Singap Med J
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Randomized Controlled Trial Clinical Trial
Combination of suppository diclofenac and intravenous morphine infusion in post-caesarean section pain relief--a step towards balanced analgesia?
Post-Caesarean section analgesia can be achieved by morphine infusion. NSAIDs are frequently administered to relieve uterine cramps. This study is aimed at assessing the efficacy of the combination of suppository diclofenac and morphine infusion in post-Caesarean section pain relief. General anaesthesia was given to 60 patients who were randomly allocated into two groups: group A received 100 mg suppository diclofenac before surgical incision and morphine infusion 1.5 mg per hour postoperatively while group B received only morphine infusion 1.5 mg/H postoperatively. Pain assessment was done by an unbiased observer on arrival of the patients in the recovery room, then 6 hours, 12 hours and 24 hours later. Pain relief was found to be better in group A, with group B requiring more supplemental analgesia. Apart from better analgesic effect for wound pain, group A also had more favourable scores for uterine cramping pain. The incidence of nausea or vomiting was similar in both groups. No respiratory depression was observed in both groups. Two cases of increased bleeding (one from each group) were observed, both receiving conservative treatment. ⋯ suppository diclofenac improved the analgesic efficacy of morphine infusion in post-Caesarean analgesia.
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Comparative Study
Bone mineral density measurements using the Hologic QD2000 in 175 Singaporean women aged 20-80.
The first aim is to obtain a reference database of bone mineral density (BMD) measurements for Singaporean women across different age groups and to compare this with an American database using the same machine. The second is to study the lifestyle factors that may influence bone mass in these women. ⋯ A local reference database is needed for the accurate interpretation of BMD measurements as there is significant variation compared to Caucasian values.
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Case Reports
Cardiac tamponade--an unlikely cause of unexplained hypotension in an isolated "minor" blunt chest injury.
Cardiac tamponade after a minor blunt chest trauma is indeed rare. Here, we report on one such case presenting with unexplained hypotension at the Emergency Department. The problems of diagnosis and treatment are discussed. In short, the proper management of this life-threatening condition can only be rendered by a high index of suspicion and close vigilance.
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Case Reports
CT and MR findings in central pontine and extrapontine myelinolysis--a study of two patients.
Central pontine and extrapontine myelinolysis is a distinctive clinical syndrome and has characteristic CT and MR features. We describe two patients who presented with nasopharyngeal carcinoma, severe hyponatremia, and had quick correction of hyponatremia. ⋯ Neurologic recovery was good in one case, and initially seen in the other patient before death resulted from septicaemia. Peripheral enhancement of the basal ganglia and caudate nuclei was seen in one patient, which we believe is a new feature.