The anatomical basis of the vascularized pronator quadratus pedicled bone graft.

The vascular supply of the pronator quadratus was studied in 25 cadaveric dissections following coloured latex injections. This showed that the main blood supply of the pronator quadratus came from the anterior interosseous artery. There was, however, a rich anastomosis between the branches of the anterior interosseous artery and those of the radial and ulnar arteries.

Alkalinization of lidocaine does not hasten the onset of axillary brachial plexus block.

Unlabelled: We assessed the onset of sensory and motor blockade as well as the distribution of sensory blockade after axillary brachial plexus block with 1.5% lidocaine hydrochloride 1:200,000 epinephrine with and without sodium bicarbonate in 38 patients. The onset of analgesia and anesthesia was recorded over the distributions of the median, ulnar, radial, and medial cutaneous nerves of the forearm, medial cutaneous and lateral cutaneous nerves of the arm, and musculocutaneous nerve.

Intrathecal pethidine: an alternative anaesthetic for transurethral resection of prostate?

We aimed to determine the usefulness of intrathecal pethidine as the sole anaesthetic for transurethral resection of prostate (TURP) while comparing the incidence of hypotension with intrathecal bupivacaine. A double-binded randomized prospective trial was conducted involving 40 patients for TURP. The patients were divided equally into two groups; group A received 2 ml 0.

Electrohydraulic lithotripsy: an effective and economical modality of endoscopic ureteric lithotripsy.

Background: Electrohydraulic lithotripsy (EHL) has been available for endoscopic treatment of urinary calculi since 1960, but the large probe size and concerns regarding safety had previously restricted its use to the treatment of bladder calculi. However, recent refinements have made it particularly suitable for the treatment of ureteric calculi.

Methods: The authors report their initial experience using EHL in conjunction with mini-ureteroscopy in the treatment of 94 ureteric calculi in 89 patients.

Helicobacter pylori infection and gastric emptying of indigestible solids in patients with dysmotility-like dyspepsia.

Background: The role of Helicobacter pylori and gastric motility in dysmotility-like dyspepsia is unclear. The aim of this study was to determine whether delayed gastric emptying of indigestible solids and H. pylori infection are associated with dysmotility-like dyspepsia.

Endoscopic injection of collagen for the treatment of female urinary stress incontinence.

Background: The objective of our study was to assess the efficacy and safety of glutaraldehyde cross-linked collagen injection in the treatment of female urinary stress incontinence.

Methods: We conducted a retrospective analysis of the records of 105 women who underwent collagen injection for urinary stress incontinence between March 1991 and April 1995. Preoperative assessment included uroflowmetry, residual urine determination, and urodynamic studies.

Abdominal computed tomography in systemic lupus erythematosus.

Sixty-five abdominal computed tomography (CT) scans of 54 systemic lupus erythrematosus (SLE) patients were retrospectively evaluated together with their clinical records. This was to assess the spectrum of CT findings and to determine the value of abdominal CT in this group of patients. Over a 3.

Evaluation of fasting plasma glucose as a screening test for diabetes mellitus in Singaporean adults.

To assess the performance of different cutoff points for fasting plasma glucose (FPG) including the World Health Organization (WHO) cutoff of FPG > and = 7.8 mmol l-1 for the screening of diabetes mellitus, data from oral glucose tolerance tests done on 865 Singaporean adults over a 4-year period were analysed. The relationship between FPG and 2 h post-load plasma glucose (2H-PG) was determined using regression analysis and receiver operating characteristic (ROC) analysis.

The ContiNet of the International Continence Society.

This is an account of the International Continence Society's ContiNet--the web server linking up continence organisations worldwide with provision to upload or download vast data stores of information on continence via e-mail, FTP, mailing lists, and special tools to seek information using "search engines." Special communication devices using internet voice/phone mail and real-time "text" or "voice" chats permit conversation globally over normal phone lines linked to the Net at local telephone rates. Special features of ContiNet include announcements of upcoming conventions, information for professionals and laypeople, and the capability to conduct research via the net and conduct consultations and discussions via newsgroups.

Cardiac tamponade--an unlikely cause of unexplained hypotension in an isolated "minor" blunt chest injury.

Cardiac tamponade after a minor blunt chest trauma is indeed rare. Here, we report on one such case presenting with unexplained hypotension at the Emergency Department. The problems of diagnosis and treatment are discussed.

Results of minor foot amputations in diabetic mellitus.

The aim of this retrospective study is to study the outcome of surgery in diabetic patients with foot infections. The results of 54 local amputations performed by surgeons of different levels of experience for gangrene and/or deep infection confined to the toes in diabetic patients were studied. Failure of surgery is defined as any case that requires subsequent surgery.

Supracondylar humeral fractures--a review of the outcome of treatment.

Fractures around the elbow are common injuries in children. We studied 77 children who had sustained supracondylar fractures around the elbow during the period 1989-1993. The aim of this study was to compare the outcomes of supracondylar fractures following 3 modes of treatment, namely manipulation and reduction, open reduction with internal fixation and percutaneous pinning.

Emergency laparoscopic procedures.

Emergency laparoscopic procedures (ELPs) have been performed since the 1960s. It never caught on due to limitations inherent in the actual procedure. Technological innovations notably in camera, electronic insufflators and light systems were key to the rebirth of laparoscopy in the late 1980s.

Working party report of the Gastroenterological Society of Singapore. Part II--Helicobacter pylori and non-ulcer dyspepsia in Singapore.

Non-ulcer dyspepsia (NUD) is a common symptom whose cause is currently unclear. Helicobacter pylori (H pylori) infection is found in half of all patients with NUD but other pathophysiological abnormalities eg delayed gastric emptying, have also been described. NUD patients with or without H pylori infection have identical symptom patterns and pathophysiological parameters.

Spectrum of roller-blading injuries.

We studied 32 patients who presented to the Accident and Emergency Department of Toa Payoh Hospital with injuries sustained while roller-blading (in-line roller skating). This sporting activity carries risk of injuries, often fractures, due to 3 principal mechanisms of injury. The first and main mechanism of injury is that of a forward fall with the arms outstretched as a protective gesture.

Unplanned returns to the accident and emergency department--why do they come back?

An audit of unplanned returns by patients to the Accident and Emergency Department was carried out recently in Toa Payoh Hospital. This was done for a period of eleven months for the year 1994. A total of 166 unplanned patient returns were studied.

A comparison of clinical and endoscopic features of bleeding and non-bleeding peptic ulcer in Singapore.

Two hundred and seventy-seven consecutive cases of peptic ulcer patients were compared. Of these, 103 presented with acute gastrointestinal haemorrhage and 174 presented with pain. The median age of those who bled (53 years) was not significantly higher than those who presented with pain (50 years) (P > 0.

Laparoscopic bladder-neck suspension for urinary stress incontinence in women: our first twenty patients.

Background: Laparoscopic bladder-neck suspension for women with urinary stress incontinence avoids the problems associated with a large abdominal incision. This study reviews the short-term outcome of this minimally invasive operation.

Methods: Between September 1993 and February 1995, 20 female patients with type II urinary stress incontinence underwent laparoscopic bladder-neck suspension at our institution (mean age, 46.

Simultaneous open dislocations of the interphalangeal and metacarpo-phalangeal joints in a thumb--a case report.

Simultaneous dislocations of the interphalangeal and metacarpo-phalangeal joints are rare. Most of the previous reports in the literature concerned closed injuries which were not associated with neurovascular involvement and were easily reduced and had favourable outcomes. They were also mainly due to a dorsally directed force on a hyperextended digit.

Working Party report of the Gastroenterological Society of Singapore. Part I--Helicobacter pylori and peptic ulcer disease in Singapore.

The Gastroenterological Society Working Party on Helicobacter pylori (H pylori) recommends eradication of H pylori in patients with peptic ulcer, provided H pylori infection has been demonstrated. H pylori treatment is not indicated for non-ulcer dyspepsia, histological gastritis or mere demonstration of H pylori infection. H pylori infection can be demonstrated by a urease test, culture or histological assessment on gastric antral biopsy or by a 13C and 14C urea breath test: serology is acceptable if validated in the local population.

Massive chylothorax after anterior fusion of the thoracic spine.

We report a case of massive chylothorax occurring postoperatively in a patient with Potts paraplegia who underwent transthoracic anterior debridement and fusion of the T7 and T8 vertebrae. This is an uncommon complication of anterior spinal surgery but has a significant morbidity and mortality. Diagnosis of the condition and the institution of the appropriate therapy will reduce this significantly.

Prostate screening--the Singapore experience.

Background: The prevalence of benign prostatic hyperplasia (BPH) is believed to be highly significant in most communities. In our country, many elderly men are unaware that something can be done for their troublesome urinary symptoms. The main objective of our prostate health screening was to educate our elderly male population that this is an abnormality, for which treatment is readily available.

Accident & emergency department diagnosis--how accurate are we?

An audit of the accuracy of diagnosis for admitted patients made by the medical officers of the Accident and Emergency Department was carried out recently in Toa Payoh Hospital. This was done for a period of one week lasting from 2nd to 8th February, 1994. A total of 122 admissions were studied and their diagnoses at admission compared with the diagnoses at discharge made by the doctors from the various discipliner in the wards.

The scapular manipulation method for reducing anterior shoulder dislocations.

Anterior dislocation of the shoulder is the most common dislocation encountered by the emergency room medical officer. Many of the present methods employed, such as Kocher's method, the Hippocratic method and distraction method, necessitate the use of both intravenous pethidine and midazolam, which prolongs the recovery time of the patient in the emergency room, as well as carrying the risk of respiratory depression. Also, such methods are associated with complications such as fractures of the humerus and injury to the axillary vessels and brachial plexus.