No abstract available.
Child* ; Humans ; Infant*

Historically, genetic counselling was developed in the West and in the field of neonatal medicine, and a non-directive approach has been its central ethos since the 1950s to 60s. In today's changing world, the question of whether non-directive genetic counselling with its emphasis on patient autonomy may in some occasions be perceived as unprofessional practice. Through these 4 case studies in cancer genetic counselling, we seek to highlight the conundrums, dilemmas and various other considerations of patients and their families faced during the genetic counselling process. We also address the pitfalls of a 'one-size fi ts all' approach of non-directive counselling and how we could best practice cancer genetic counselling in the Singapore context, taking into consideration respect for patient autonomy and healthcare professionalism.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ethics, Medical ; Female ; Genetic Counseling ; Genetic Testing ; Humans ; Male ; Middle Aged ; Mutation ; Neoplasms ; genetics ; Pedigree ; Personal Autonomy ; Professional Practice ; ethics ; Risk Assessment ; Risk Factors ; Singapore ; Young Adult

Fracture healing in the hand is not an isolated goal. The functional end result is of paramount importance. When the correct techniques are used, miniplate fixation for metacarpal and phalangeal fractures of the hand provides rigid internal fixation, stabilizes the skeleton, preserves the gliding tissue, and therefore allowing immediate active range of motion exercise as well as minimizing joint and tendon complications. The authors have reviewed 39 patients, 52 cases of metacarpal and phalangeal fractures of the hand which were treated with miniplate in the department of orthopaedic surgery, Chang Ang Gil hospital from Sep. 1989 to Feb. 1993. The following results were obtained. 1. Miniplate fixation, in terms of fracture reduction and maintenance, allows on accurate anatomic reduction with rigid fixation which in turn affords on early mobilization without loss of reduction alignment. 2. The roentgenographic union was obtained within 15.1 weeks in average. The mean total acitve motion at the fractured finger was 230°. The complication rate was 11.5%. 3. In the treatment of metacarpal and phalangeal fractures of the hand, especially fractures of metacarpal bones, fixation with miniplate is considered to be an useful method in terms of getting fracture union and good range of motion with relative low complication rates.
Early Ambulation ; Fingers ; Fracture Healing ; Hand ; Humans ; Joints ; Metacarpal Bones ; Methods ; Range of Motion, Articular ; Skeleton ; Tendons

No abstract available.
Child* ; Humans ; Hydronephrosis*

Background: This study aimed to assess the efficacy of the adductor canal block (ACB) in comparison to intra-articular steroid-lidocaine injection (IASLI) to control chronic knee osteoarthritis (KOA) pain. Methods: A randomized, single-blinded trial in an outpatient rehabilitation clinic re-cruiting chronic KOA with pain ≥ 6 months over one year. Following randomization,subjects received either a single ACB or IASLI under ultrasound guidance. Numerical rating scale (NRS) scores for pain, and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were recorded at baseline, 1 hour, 1 month, and 3 months postinjection. Results: Sixty-six knees were recruited; 2 were lost to follow-up. Age was normally distributed (P = 0.463), with more female subjects in both arms (P = 0.564). NRS scores improved significantly for both arms at 1 hour, with better pain scores for the IASLI arm (P = 0.416) at 1st month and ACB arm at 3rd month (P = 0.077) with larger effect size (Cohen’s d = 1.085). Lower limb function improved significantly in the IASLI arm at 1 month; the ACB subjects showed greater functional improvement at 3 months (Cohen’s d = 0.3, P = 0.346). Quality of life (QoL) improvement mirrored the functional scores whereby the IASLI group fared better at the 1st month (P = 0.071) but at the 3rd month the ACB group scored better (Cohen’s d = 0.08, P = 0.710). Conclusions ACB provides longer lasting analgesia which improves function and QoL in chronic KOA patients up to 3 months without any significant side effects.

A 36-year-old female patient with aplastic anemia developed massive hemoptysis and was placed on ventilator support. However, airway obstruction by blood clots triggered desaturation and ventilator malfunction. Manual ventilation was initiated to improve oxy-genation, and emergency flexible bronchoscopy was performed to clear the airway. Nevertheless, the patient developed extensive subcutaneous emphysema, pneumothorax, and pneumomediastinum.
Adult ; Airway Obstruction ; Anemia, Aplastic ; Barotrauma* ; Bronchoscopy ; Emergencies ; Female ; Hemoptysis* ; Humans ; Mediastinal Emphysema ; Pneumothorax ; Subcutaneous Emphysema ; Ventilation* ; Ventilators, Mechanical

No abstract available.
Angina, Unstable*

Spinal anesthesia has been safely and reliably performed in minor pediatric surgery. Preterm infants are more likely to develop respiratory or cardiovascular complications after general anesthesia than full tern infants. This regional anesthesia may offer special advantages for surgical procedures such as inguinal hernia repair in former premature infants with a history of apnea and bradycardia of prematurity. Spinal anesthesia was done in sixty seven infants and children under 15 years of age, who were to undergo minor abdominal and lower extremity orthopedic procedure. In all cases 0.25 mg/kg of 0.5% hyberbaric tetracaine was injected into subarachnoid space. Age-related 4 groups (0~1, 1~6, 6~12, 12~15 years-old) were divided. The depth of lumbar puncture, sensory block, hemodynamic changes, status of sedation, duration of anesthesia, complication following spinal anesthesia were observed. The results were as follows; 1) Lumbar puncture was successed in 66 cases(98.5%), but failed in 1 case(1.5%). 2) The highest correlation in depth of lumbar puncture was with body-surface area(y=1.19+2.06x, r=0.956, p<0.001). 3) The mean height of sensory block in all age-related groups was similar between T(5) to T(6) skin dermatome. 4) Chidren less than 6 years of age showed a little changes in blood pressure and heart rate following spinal anesthesia. But children more than 6 years of age had widely varible decreases in blood pressure and heart rate, and recieved ephedrine(4 cases) or atropine(2 cases). 6) 55 cases(82.1%) required sedation with midazolam or propofol, 8 cases(10.6%) required general anesthesia to complete operative procedure. 7) The time needed to regain motor funtion increased with age (y=1.04+/-O.llx, r=0.952, p<0.001). 8) Preoperative complications were bloody tap (5 cases), hypotension (14 cases), bradycardia (6 cases), nausea or vomiting (4 cases), insufficient analgesia (2 cases), and failed tap (1 case). Postoperative complication was nonspecific postdural puncture headache (1 case). From the above results, it was suggested that spinal anesthesia without use of potent inhalational anesthetics in minor pediatric surgery is one of useful method under meticulous monitoring and observation.
Analgesia ; Anesthesia ; Anesthesia, Conduction ; Anesthesia, General ; Anesthesia, Spinal* ; Anesthetics ; Animals ; Apnea ; Blood Pressure ; Bradycardia ; Charadriiformes ; Child ; Heart Rate ; Hemodynamics ; Hernia, Inguinal ; Humans ; Hypotension ; Infant ; Infant, Newborn ; Infant, Premature ; Lower Extremity ; Midazolam ; Nausea ; Orthopedic Procedures ; Post-Dural Puncture Headache ; Postoperative Complications ; Propofol ; Skin ; Spinal Puncture ; Subarachnoid Space ; Surgical Procedures, Operative ; Tetracaine ; Vomiting

PURPOSE: The efficiency of the initial screening methods for the detection of urologic malignancies was evaluated with regard to each cancer detection rate. MATERIALS AND METHODS: Of the 117,023 people (Male:Female=1.5:1) who received general health examinations between 2000 and 2003, 4,000 (3.42%) were referred to the department of urology. It was recommended that the referred patients receive the following additional tests: intravenous pyelography (IVP) and cystourethroscopy for microscopic hematuria, a prostate biopsy after digital rectal examination to elevate prostate-specific antigen (PSA) above 4ng/ml and dynamic computerized tomography of the kidney for any abnormality on the ultrasonography. RESULTS: A microscopic hematuria was detected in 2,253 people (1.93%), PSA evaluated in 620 (0.89%) and an abnormality of the kidney on ultrasonography in 1,127 (0.96%). One diagnosis was of a bladder tumor, which turned out to be a pTaG2. Twenty seven were found to have prostate cancer, which was organ confined in 13, locally advanced in 7 and systemically advanced in 3. Four men refused further evaluation or management. A renal cell carcinoma (stages pT1a-bN0M0G1-3) was diagnosed in the 10 people having undergone partial or radical nephrectomies and 2 having undergone a nephroureterectomy were diagnosed with a transitional cell carcinoma (stages pT1 and 3bN0M0G3) of the renal pelvis. CONCLUSIONS: In the screening of kidney and bladder cancers, the detection rates and cancer stages attributed to ultrasonography and microscopic hematuria are lower. However, the rates of prostate cancer detected by PSA, and their stage, both seem to be higher. It is our belief that greater information and an earlier PSA test will allow the detection of prostate cancer at a lower stage.
Biopsy ; Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis ; Digital Rectal Examination ; Health Promotion* ; Hematuria ; Humans ; Kidney ; Kidney Pelvis ; Male ; Mass Screening ; Nephrectomy ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Ultrasonography ; Urinary Bladder Neoplasms ; Urography ; Urology

BACKGROUND: Mitral and pulmonary venous(PV) flow velocity variables are being used for the indirect evaluation of left ventricular(LV) diastolic function. However, these flow velocities are influenced by age, loading conditions and other factors. This study was designed to evaluate usefulness of left atrial size and function in addition to the relation of mitral and PV flow velocity variables in the estimation of LV filling pressures. METHODS: Mitral and PV flow velocity variables. left artial size and function were assessed just before a cardiac catherization in 31 patients. According to the LV filling pressures, patients were divided into two subgroups and echocardiographic variables were compared. RESULTS: 1) LV end-diastolic pressure was related to the duration of reverse flow in the PV at atrial contraction(r=0.58) and difference in mitral and PV flow velocity duration at atrial contraction(r=0.54), and the similar findings were observed in other left ventricular filling pressures. 2) Left atrial size and volumes were greater in the subgroup of abnormal LV filling pressures(P < 0.05), but left atrial ejection fraction was not different between subgroups. CONCLUSION: In addition to variables of the mitral and PV flow velocities, left atrial size and volume may provide an additive value in the estimation of left ventricular filling pressures.
Echocardiography ; Echocardiography, Doppler ; Humans