Right Living Donor Nephrectomies: Retroperitoneoscopic vs Laparoscopic Transperitoneal Approach.

Retroperitoneoscopic right living donor nephrectomy (RLDN) provides direct access to the renal hilum without the need to mobilize the colon. However, factors such as lack of anatomic landmarks to guide orientation, smaller working space, and steep learning curve provided a debate against this approach. In this retrospective study, we reviewed our single-center experience of retroperitoneoscopic RLDN. MATERIALS AND METHODS: Between January 2015 and January 2017, 10 patients underwent retroperitoneoscopic RLDN by a single surgeon at the National University Hospital, Singapore. Baseline demographics, intraoperative parameters, and both donor and recipient outcomes were retrieved from the database. RESULTS: Mean (SD) age was 52.7 (13.8) years, mean (SD) body mass index was 25.2 (2.9) kg/m2, mean (SD) operating time was 196.8 (38.0) minutes, mean (SD) warm ischemic time was 5.1 (2.1) minutes, and mean (SD) blood loss was 43 (25.0) mL. Mean (SD) renal vein length was 10 (2.5) mm, and mean (SD) renal artery length was 6 (1.8 mm). One patient had to be converted to laparoscopic transperitoneal nephrectomy. No donors developed complications. Mean (SD) hospital stay was 3.5 (1.1) days. All transplanted right kidneys had immediate graft function with no complications. Mean (SD) serum creatinine (at 1 year) was 103.6 (20.3) µmol/L. There is no graft loss among the recipient after 1 year. CONCLUSIONS: Right donor nephrectomy can be performed safely using retroperitoneoscopic approach. Retroperitoneoscopy offers advantages, especially in a patient who previously had transabdominal surgery or high body mass index. However, transperitoneal approach may be preferable in anomalous situations because it provides instinctive orientation from anatomic landmarks and a greater working space.

Ministry of Health clinical practice guidelines: depression.

The Ministry of Health (MOH) have updated the clinical practice guidelines on Depression to provide doctors and patients in Singapore with evidence-based treatment for depression. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Depression, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/home/Publications/guidelines/cpg/2012/depression.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Ministry of Health clinical practice guidelines: schizophrenia.

The Ministry of Health (MOH) has updated the clinical practice guidelines on Schizophrenia to provide doctors and patients in Singapore with evidence-based treatment for schizophrenia. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Schizophrenia, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov. sg/mohcorp/publications.aspx?id=26138. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

A survey of symptoms in hospice patients in Singapore.

A descriptive study was done on patients referred to a hospice home care service in Singapore. The demographic profile, type of disease, presenting symptoms and performance status were noted. Particular attention was paid to the incidence of pain and types of analgesics used. The patients referred were representative of the population at large, as was their incidence of cancer. Eastern Cooperative Oncology Group (ECOG) performance status was poor (ECOG 3 or 4) in 93 (93%) of the patients referred, indicative of the lateness of referral in many cases. The number of symptoms per patient averaged 5.8, and pattern of symptoms were similar to those of comparable groups of patients in other parts of the world. Pain was present in 82 (82%) patients and controlled only in 22 (22%) of these at presentation. Strong opioids had been prescribed for 51 (51%) patients. In these, oral morphine mixture was incorrectly prescribed in 17 (47%) out of 36 cases. Education in palliative care is needed so that patients are referred to palliative care services appropriately. Though there is some indication of improvement, medical education in pain management continues to be necessary, particularly in the correct prescription of morphine.

Psychiatric referrals in the general hospital.

Psychiatric disorders and physical illnesses often coexist. Although there is evidence of high psychiatric morbidity in general hospital patients, only a small percentage are referred to the consultation-liaison psychiatrist. The paper describes and discusses the common psychiatric conditions encountered and referred in general hospitals. They include attempted suicides, psychiatric disorders presenting with physical symptoms, organic psychiatric disorders presenting with psychiatric symptoms and the psychiatric consequences of physical illness. The major diagnostic categories of these referrals are organic psychotic disorders, functional psychoses and neurotic disorders. Some broad guidelines are listed for the referring physician. Patients presenting with suicidal ideations or attempts, suspected emotional psychiatric disturbance, a history of psychiatric illness, an apparent incompetence in giving consent for medical procedures and those with diagnostic and management problems could be referred to the psychiatrist.

Psychiatric referral pattern in a general hospital.

Between September 1986 and January 1988, a sixteen-month period, a total of 494 inpatients in Tan Tock Seng Hospital were referred for psychiatric opinion. 181 were referred for suicidal tendency and 313 for other reasons. An analysis of these two groups of referrals was done to study any change in referral trends. The findings show that while the basic diagnostic categories of patients do not differ drastically from an earlier study in Singapore General Hospital by Tsoi and Kok, Tan Tock Seng Hospital had its own pattern of requirements for psychiatric consultation because of its own unique patient characteristics.

A comparative study of pipothiazine palmitate and fluphenazine decanoate in the maintenance of remission of schizophrenia.

This paper reports a randomized, controlled, partially-blinded, flexible dose, parallel group, comparative study of the efficacy and tolerance of pipothiazine palmitate and fluphenazine decanoate in patients in remission from Schizophrenia over a 28 week period. The results show that pipothiazine palmitate is at least as efficacious and well-tolerated as fluphenazine decanoate in preventing relapses from maintained Schizophrenia.