Singap Med J
-
This study is the first to document the prevalence of insomnia in Malays and Chinese in a Singapore community. The overall rate of insomnia was low at 15.3% with females and Malays at higher risk. ⋯ There was an association between insomnia patients with increased stress levels, especially at home, and a higher rate of co-morbid minor psychiatric disorder. However, most patients do not seek medical help, and even less resort to sleeping pills.
-
To determine those factors responsible for continuing prevalence of liver damage after paracetamol poisoning, 222 Chinese patients presenting to the Prince of Wales Hospital, Hong Kong from 1988 to 1993 were studied. Of the 27 patients with plasma paracetamol concentrations above the recommended "treatment line", 13 developed liver damage. Time elapsed between ingestion and treatment with intravenous N-acetylcysteine (NAC) was the most important prognostic factor. ⋯ Liver damage in some of the remaining patients (30%) could have been prevented if NAC was started in the Emergency Department within 8-15 hours of ingestion. Liver damage after paracetamol poisoning remains common (5.9%) in Hong Kong because of the failure to give NAC appropriately or late presentation. We hope to improve patient management by repeatedly emphasising the importance of adherence to the standard protocols and having the toxic plasma level results phoned directly to the duty registrars.
-
Venography is often requested to confirm the clinical suspicion of deep vein thrombosis (DVT) in patients with calf pain or swelling. Often, no clots could be demonstrated and the patients are discharged without a confirmed diagnosis. It is now being increasingly recognised that a Baker's (popliteal) cyst, ruptured or otherwise, may simulate deep vein thrombosis. ⋯ Baker's cysts were confirmed on subsequent knee arthrograms, ultrasonography or magnetic resonance imaging (MRI). It is emphasised here that a failure to demonstrate DVT in a patient with signs and symptoms, of DVT should prompt a search for Baker's cyst. The pathological anatomy of Baker's cyst is briefly reviewed with the aid of magnetic resonance images.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Oral premedications in paediatric day surgery.
The degree of sedation in 191 day-stay children after oral premedication were compared. One hundred and forty-six were 1-5 years old (Group 1) and were randomised to receive either chloral 40 mg/kg, midazolam 0.2 mg/kg, promethazine 1 mg/kg, trimeprazine 3 mg/kg or placebo. Forty-five were 5-12 years old and were randomised to receive either trimeprazine 3 mg/kg, midazolam 0.2 mg/kg or placebo (Group 2). ⋯ They were assessed on leaving the ward, at separation from the parents, at induction, in the recovery room and one and two hours after returning to the ward. In Group 1, it was found that chloral and trimeprazine gave the best degree of sedation but the sedative effect of trimeprazine lasted longer into the post operative period. In Group 2, it was found that the children did not require deep sedation and the anxiolysis obtained with midazolam was adequate.
-
We report a case of cervicofacial actinomycosis with paravertebral extension in a 60-year-old man who presented with recurrent neck masses. Diagnosis was confirmed on culture and histology of pus and debris obtained from surgical drainage. He improved only after lengthy in-hospital high dose penicillin therapy. He is currently well and is on maintenance doxycycline therapy for 6 months following the high dose penicillin therapy.