Ann Acad Med Singap
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Thrombophilia refers to disorders which are associated with a persistent hypercoagulable state and a tendency towards thrombosis. They may be inherited, acquired or complex, when genetic factors interact with environmental influences. The objective was to review the various inherited thrombophilias and the antiphospholipid syndrome in relation to pregnancy-related venous thromboembolism and other obstetric complications. ⋯ Venous thromboembolism is now recognised as a multicausal and multigenic condition. This is particularly evident in pregnancy where multiple risk factors interact and are often identified in women who develop venous thrombosis. With the discovery of factor V Leiden and the prothrombin gene G20210A mutation, inherited thrombophilia can now be detected in a significant proportion of Caucasians who develop venous thromboembolism; however, both these mutations are rarely found in Asians. Identifying women at risk for venous thromboembolism and instituting thromboprophylaxis appropriate to the level of risk remains the key to reducing morbidity and mortality from the condition. Additional research into the intensity, type and duration of thromboprophylaxis for different levels of risk are required. The role of inherited thrombophilia in the pathogenesis of obstetric complications needs to be further defined before screening can be recommended for indications other than venous thromboembolism.
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Ann Acad Med Singap · May 2002
Comparative Study Clinical TrialPreliminary experience in radionuclide therapy of hepatocellular carcinoma using hepatic intra-arterial radio-conjugates.
In a minority of the cases, resection of hepatocellular carcinoma (HCC) is potentially curative but local recurrence is common. Adjuvant intra-arterial radio-conjugate therapy could potentially reduce the rate of local recurrence and increase disease-free and overall survival. However, in the majority of cases, treatment of HCC is largely palliative. A wide range of palliative treatment options are available and these include external radiation, hepatic intra-arterial chemo-embolisation, systemic chemotherapy and percutaneous ethanol injection. The long-term survival rate is poor. Hepatic intra-arterial radio-conjugate therapy provides a new and promising means of palliation. ⋯ Our results in the adjuvant treatment of patients with I131 lipiodol following curative resection of early HCC and in the palliative treatment of unresectable HCC using Y90 microspheres and Re188 lipiodol are preliminary and not fully conclusive. These preliminary results have to be confirmed in larger groups of patients and by prospective, randomised, controlled trials. This study highlights the preliminary experience in radionuclide therapy of HCC using hepatic intra-arterial radio-conjugates in a local context.
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Ann Acad Med Singap · May 2002
The acute presentation of pulmonary thromboembolism: a retrospective viewpoint.
Acute pulmonary thromboembolism (PE) has been considered rare among Asians. We aim to describe the frequency and clinical features of this condition in a hospital in Singapore. Among patients admitted by the Emergency Department (ED), comparisons were made between those primarily diagnosed in the ED and those who were not. ⋯ Acute PE is not as rare here as previously thought. Clinical features reveal more similarities than differences compared to other studies in the literature. We advocate a high index of suspicion for earlier diagnosis in the ED.
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Ann Acad Med Singap · May 2002
Pregnancy after renal transplantation: experience in Singapore General Hospital.
Renal transplantation offers the best hope for those women with end-stage renal disease who wish to have children. However, pregnancy after renal transplantation is associated with increased maternal and fetal morbidity. The aim of this retrospective study was to review the outcome of pregnancy in renal transplant patients in Singapore General Hospital. ⋯ Successful pregnancy is possible in women after renal transplantation. Such pregnancy is often associated with increased maternal and fetal complications and should be managed by a multidisciplinary approach in a tertiary centre. The function and survival of renal allograft was not adversely affected by pregnancy.
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Ann Acad Med Singap · May 2002
Outcome of pregnancy in Asian women with systemic lupus erythematosus: experience of a single perinatal centre in Singapore.
To study maternal and fetal outcomes in women with systemic lupus erythematosus (SLE). ⋯ Good pregnancy outcomes can be expected in women with SLE in remission. Pre-pregnancy counselling is crucial to achieve this. All pregnancies should still be considered high risk and be managed jointly between the obstetricians, the perinatologists and the physicians. In particular, those with renal impairment are at increased risk of IUGR, superimposed pre-eclampsia and preterm births. Co-existing APS augurs a poorer prognosis for pregnancy outcome, and may present atypically as autoimmune haemolytic anaemia in the postpartum period.