Singap Med J
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Psychiatric disorders and physical illnesses often coexist. Although there is evidence of high psychiatric morbidity in general hospital patients, only a small percentage are referred to the consultation-liaison psychiatrist. The paper describes and discusses the common psychiatric conditions encountered and referred in general hospitals. ⋯ The major diagnostic categories of these referrals are organic psychotic disorders, functional psychoses and neurotic disorders. Some broad guidelines are listed for the referring physician. Patients presenting with suicidal ideations or attempts, suspected emotional psychiatric disturbance, a history of psychiatric illness, an apparent incompetence in giving consent for medical procedures and those with diagnostic and management problems could be referred to the psychiatrist.
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Comparative Study
Comparison of the results of spinal fusion for spondylolisthesis in patients who are instrumented with patients who are not.
Eighty-five patients who had surgery for spondylolisthesis were studied retrospectively both clinically and radiologically to determine if instrumentation lead to better fusion rates and clinical outcome. Degenerative spondylolisthesis accounted for 57 cases and patients who had instrumentation did have a better fusion rate and clinical outcome, with 60% of patients having complete relief from pain. In the group with isthmic spondylolisthesis (28 patients), there was also an improved fusion rate with instrumentation. ⋯ The improved fusion rate radiologically with instrumentation did not translate to better clinical results with regard to pain relief and disability. One patient developed ascending epidural haematoma with instrumentation and resulted in paraplegia. She had incomplete recovery during the follow-up.
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Patients with the Hb beta + [IVS 1-5 (G-->C)] clinically presented as beta-thalassaemia intermedia and remained asymptomatic in the absence of blood transfusions. With or without blood transfusions the patients were short and had moderate to marked thalassaemia facies. ⋯ The serum ferritin and serum alanine transaminase levels were significantly raised in the patients who were given blood transfusions. In the presence of blood transfusions, and absence of adequate iron chelation therapy, splenectomy became an inevitable event at some stage of the disease because of increasing transfusing requirements.
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Mammography has been in general use as a breast imaging procedure for many years. More recently, it has taken on another important role, as a screening procedure for breast cancer. This article reviews its effectiveness in reducing morbidity and mortality resulting from the disease.
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A retrospective study of the use of autologous bone marrow injection for the treatment of delayed and non-union of long bones in an Orthopaedic Department, Singapore General Hospital from 1990-1991 is presented. There were 10 patients with 11 fractures (8 tibia and one each of humerus, femur and radius-ulna) available for study. Percutaneous injection of autologous marrow alone was used to stimulate healing of delayed and non-unions treated initially by plating, external fixation and in one case, by plaster cast. ⋯ There was one case of infection but none of the significant donor site morbidity was associated with standard open autologous grafting. Bone marrow injection was effective in stimulating bony union, with numerous advantages and considerably lower morbidity compared with standard open autologous grafting. Shorter inpatient stay was a significant feature.