Hong Kong medical journal = Xianggang yi xue za zhi / Hong Kong Academy of Medicine
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An increasing number of minor surgical procedures are performed under local anaesthesia in clinical settings outside the operating room, where monitoring and resuscitation equipment--as well as personnel skilled in resuscitation--may not be readily available. Serious adverse effects and even fatalities may result from the use of local anaesthetic agents, arising from a variety of causes such as systemic toxicity, allergy, vasovagal syncope, and reaction to additives present in the local anaesthetic. This article briefly reviews the pharmacology of local anaesthetic agents, and describes various techniques commonly used for local anaesthesia, with special emphasis on safety. Clinical features of toxicity, and its differential diagnosis and management, are also discussed.
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Review Case Reports
Meningoencephalitis caused by Bacillus cereus in a neonate.
We report on a newborn boy, who was delivered at 26 weeks' gestation by emergency caesarean section because of a prolapsed cord and breech presentation. Grade IV hyaline membrane disease subsequently developed, for which a surfactant was given. On day 8, there were frequent apnoeic attacks, and on day 30, marked irritability developed, as did intermittent stiffening of all four limbs. ⋯ Severe cerebral oedema developed, however, and computed tomography of the brain showed bright cortical sulci, suggestive of meningitis. The baby died on day 37, and post-mortem histological examination of the brain showed extensive liquefactive necrosis with abundant neutrophilic infiltration. Since infection with Bacillus cereus is rapidly fatal, early recognition of infection by this organism is important.
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To review the factors involved in determining the availability of solid organs for transplantation in Hong Kong and to identify methods that have been used in other countries to increase organ donation rates. ⋯ Greater effort should be directed through public education at the importance of telling one's family what one's wishes are concerning organ donation. More information is required in Hong Kong as to why families agree to organ donation and how best to approach families to request organ donation.
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The perception of emergency medicine as a defined specialty may vary widely in different locations around the world. While no single emergency medical system can fulfil the needs of all countries, there are three main models of delivery: the European model, the Anglo-American model, and the neglect model. This article reviews aspects of emergency medical systems around the world and compares the European and Anglo-American models of emergency care. The current state of emergency medicine in Hong Kong is also presented, including challenges facing the specialty as we enter the 21st century.
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Review
A 12-month review of autopsies performed at a university-affiliated teaching hospital in Hong Kong.
To review the autopsies performed at a university-affiliated teaching hospital over a 12-month period. ⋯ Autopsy is a valid medical quality-assurance mechanism in Hong Kong.