Ann Acad Med Singap
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Ann Acad Med Singap · Jan 1992
Transient hypoalgesia under physical exercise--relation to silent ischaemia and implications for cardiac rehabilitation.
A series of studies with humans as well as experiments carried out on animals could show that physical exercise leads to temporary hypoalgesia. Reduced sensitivity to pain is not only demonstrable after long-distance exercise (such as marathon run) but also after intensive physical exercise on a laboratory ergometer. Pain threshold elevation is most pronounced during maximal exertion, but hypoalgesia remains present also after exercise is stopped demonstrating that a systemic analgetic effect is induced by the exercise process. ⋯ Stress-induced hypoalgesia plays also a role in the coronary heart disease. The activation of endogenous analgetic mechanisms leads to a part of the myocardial ischaemia provoked by exercise being silent under exercise. Completely asymptomatic myocardial ischaemia patients display a generalized hypoalgesia which is demonstrable independent of an exertion stimulus and which indicates a central set-point change in the antinociceptive system.
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Ann Acad Med Singap · Nov 1991
Pacing experience with the atrial screw-in leads at the Singapore General Hospital.
This is a retrospective study of atrial screw-in leads implanted at the Singapore General Hospital from January 1988 to August 1990. There were 21 (13 female and 8 male) consecutive patients, with age ranging from 17 to 79 years (mean 55 years). Thirteen patients had sick sinus syndrome and the remaining eight patients had high grade AV block. ⋯ On follow-up ranging from one month to two years, two patients had inadequate sensing in the atrium and one patient had high pacing threshold. There were no lead dislodgement. In conclusion, these screw-in leads can be safely used in the atrium with acceptable pacing characteristics.
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Ann Acad Med Singap · Nov 1991
Case ReportsA non-fatal case report of acute fatty liver of pregnancy.
Acute fatty liver of pregnancy (AFLP) is a potentially fatal disorder that typically complicates the third trimester of pregnancy. Unrecognised, acute fatty liver of pregnancy may rapidly progress to fulminant hepatic failure, disseminated intravascular coagulation, acute renal failure and death. ⋯ The diagnostic criteria of AFLP are met if third trimester jaundice is associated with hyperuricaemia, the presence of nucleated red blood cells in the peripheral blood film and hepatic attenuation values consistent with fatty infiltration by at least one imaging technique. We report here a 38 year old Chinese woman with acute fatty liver of pregnancy, a non-fatal case complicated by extrahepatic manifestations of disseminated intravascular coagulation, haemorrhage and renal dysfunction.
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Ann Acad Med Singap · Jul 1991
Intraoperative anaesthetic management of the liver transplant patient.
Orthotopic liver transplantation has become an established method of treating end-stage liver disease. Anaesthesia for patients undergoing this procedure can be complicated because end-stage liver disease is often associated with dysfunction of other physiological systems. ⋯ The increased understanding of the pathophysiology of the procedure and the use of dedicated rapid infusion systems and intraoperative blood salvage have helped to improve the intraoperative management of the liver transplant patient. Co-operation and communication between the blood bank, haematology, biochemistry, surgical and anaesthesia services are vital.
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Ann Acad Med Singap · May 1991
Randomized Controlled Trial Clinical TrialCetirizine vs placebo in chronic idiopathic urticaria--a double blind randomised cross-over study.
The efficacy of cetirizine dihydrochloride, a new H1-antagonist claimed to have minimal sedative property was evaluated in 28 patients with chronic idiopathic urticaria. Cetirizine 10 mg and placebo were compared in a double-blind cross-over trial. Response was measured by patients with daily charts on itch and wheals. ⋯ Five of the 28 (17.9%) patients reported mild drowsiness while taking cetirizine. Two patients reported drowsiness while on placebo. Tolerance was reported as good in 85%, moderate in 10% and bad in 5% according to patients' assessment, while tolerance was excellent and good in 80%, moderate in 15% of patients according to investigator's assessment.