Ann Acad Med Singap
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Ann Acad Med Singap · Apr 1987
Case ReportsHistopathology of the testes from male transsexuals on oestrogen therapy.
This study was conducted to determine whether the histopathology of the testis of the male transsexual would throw light on the pathogenesis of male transsexualism. Histological sections of testicular tissues obtained at sex reassignment surgery from phenotypic male transsexuals (n = 10, age 21-33 years) with XY sex chromosome constitution were studied by light microscopy. ⋯ The significant histological findings in the ten subjects were: (i) Focal or normal spermatogenic activity associated with normal Leydig cell population in three cases, and (ii) Total absence of spermatogenic activity associated with reduced Leydig cell population in seven cases. We suggest that the observed histological features are due to refractoriness to oestrogen, and the iatrogenic effects of oestrogen superimposed on normal or altered hypoathalamo-pituitary function.
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The increased production and excretion of oxalate in primary hyperoxaluria causes urolithiasis, nephrocalcinosis with renal failure, and systemic oxalosis. Systemic oxalosis occurs late in the course of the disease when there is both oxalate retention and increased oxalate synthesis. The uraemia can be controlled by conventional haemodialysis or peritoneal dialysis but treatment cannot usually keep up with accelerated rate of oxalate production, and dialysed patients develop systemic oxalosis. ⋯ We conclude provisionally that vigorous haemodialysis should be begun and transplantation arranged when the GFR reaches this level. Such early transplantation with vigorous perioperative haemodialysis and a large perioperative diuresis of water gives good immediate graft function and oxalate mobilisation from the miscible oxalate pool. The longer term outlook is then influenced more by the factors which determine the success of renal transplantation in non-hyperoxaluric patients.
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Ann Acad Med Singap · Jan 1987
Reactions to death and dying by doctors, medical students and nurses in Singapore 1985-86.
Questionnaires concerning their own death were given to groups of general practitioners, final year medical students, 2nd year medical students, post-basic nurses, nurses working with the home nursing foundation and religious nursing sisters. The results of the questionnaire indicate that the majority wish to die at home with their families present, and would like spiritual advice. The majority of the respondents believe in a life after death. ⋯ The majority were not satisfied with the level of care given. Further support for the professional carers in the form of multidisciplinary seminars, and the formation of a hospice movement was deemed necessary by the majority. The greatest indication of problems in satisfying the needs of the dying patient and the family is in the desire to legislate euthanasia by 23% of doctors and 38% of nurses.
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Ann Acad Med Singap · Jul 1986
Randomized Controlled Trial Clinical TrialA study of inhalational sedation with nitrous oxide/oxygen for oral surgery in Hong Kong Chinese.
Thirty healthy Chinese between 17-36 years undergoing extraction of bilaterally similarly impacted third molars in two visits were randomly given nitrous oxide/oxygen inhalational sedation to supplement local anaesthesia or unsupplemented local anaesthesia for operation on one side and the alternative for the other. The majority in the study had never heard of inhalational sedation being available to supplement local anaesthesia, and when given a chance to experience this method, the majority preferred it to local anaesthesia alone. ⋯ With both methods, the operating conditions were assessed to be good, with good patient co-operation. Inhalational sedation with nitrous oxide/oxygen had no significant effect on vital signs, intraoperative or post operative adverse effects and patients were street fit within ten minutes of ending sedation.
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Ann Acad Med Singap · Oct 1985
Randomized Controlled Trial Comparative Study Clinical TrialIs preoperative shaving really necessary?
A randomised prospective study was done to assess the necessity of shaving before operation. Seven hundred and sixteen cases were included in this study. ⋯ The clean wound infection rate was 5.08% for the traditional method group and 5.56% for the alternate method group. The results suggest that routine shaving, as part of preoperative preparation, has no advantage in reducing wound infection rate.