Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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Case Reports
Two case reports of obturator nerve block for transurethral resection of bladder tumour.
This report describes two cases of severe adductor muscle spasm during transurethral resection of bladder tumours and subsequent successful management with the help of obturator nerve block. Obturator nerve blocks are useful during surgery to remove large, advanced tumours in the distal lateral wall of the bladder.
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To examine the status of obstetric epidural analgesia services in Hong Kong public hospitals in 2001, and to compare findings with those from a similar survey conducted in 1995. ⋯ Although there has been progress and improvement in the provision of obstetric epidural analgesia services in our public hospitals, the rate is still relatively low and the provision of services after hours is limited. Further progress will likely be hindered by current or future cutbacks in public hospital budgets.
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Chrysomya bezziana is a causative agent of obligatory myiasis. We report the first case of human infestation of Chrysomya bezziana in Hong Kong in an 89-year-old woman who had previously had a stroke. One day after hospital admission for fever, a small fissure at the labial gingiva of the upper incisors and several ulcerative lesions at the hard palate were noticed during routine mouth care. ⋯ The tissue loss was limited to the bony margin of the hard palate. The infestation was managed by manual removal of maggots and surgical debridement. Medical personnel taking care of old or debilitated patients need to bear in mind the possibility of Chrysomya bezziana infestation to be able to make a prompt diagnosis and implement relevant intervention to prevent extensive tissue destruction.
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An 88-year-old woman with an undiagnosed chronic subdural haematoma underwent emergency repair of a femoral hernia under spinal anaesthesia. The patient complained of headache postoperatively, and a subsequent computed tomography brain scan showed an acute-on-chronic subdural haematoma, with midline shift and impending coning. The patient recovered completely after surgical decompression. The difficulty in diagnosing chronic subdural haematoma in the elderly patient with no history of trauma is discussed, along with the differential diagnosis of headache following spinal anaesthetic in this age-group.