Ann Acad Med Singap
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Ann Acad Med Singap · Jul 1988
Nonsurgical correction of cleft lip nasal deformity in the early neonate.
Auricular cartilage is soft and plastic, and congenital auricular deformities are easily corrected nonsurgically in the early neonatal period. Alar cartilage is the same kind of elastic cartilage as auricular cartilage. Therefore, alar cartilage is also malleable in the early neonate. ⋯ In 10 cases, preoperative nonsurgical correction with a special retainer began in the early neonatal period and the lip repair was done at about three months of age. Following observation of 40 infants for 12 months or longer, their nasal shapes and symmetry were considered superior to those conventionally operated on at about three months of age without nonsurgical correction of their nasal deformity during the early neonatal period. Except for one case of nasal infection, there were no other complications.
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Ann Acad Med Singap · Jan 1988
The use of serum transferrin in the evaluation of protein-calorie malnutrition in cancer patients.
Forty-five patients with various malignancies of the gastrointestinal tract had their nutritional status assessed pre-operatively to determine the prevalence of malnutrition and to establish the correlation of malnutrition with post-operative outcome. Ten nutritional parameters were assessed. Based on these markers, we found a significant degree of malnutrition. ⋯ We feel that serum transferrin is a useful nutritional marker to predict post-operative outcome and also to monitor the effect of nutritional support. However, based on a preliminary study, nutritional support may be required for periods longer than two weeks to show significant improvement in protein-calorie malnutrition. We will consider giving adequate support for a longer period on a further study using serum transferrin as a marker to determine its value in monitoring any reversal of malnutrition.
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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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Medical jurisprudence in the local context would require the examination of a wide area. This paper focuses on liability producing conduct arising from the providing of medical services, other than liability for criminal negligent conduct. It examines the circumstances in which the physician-patient relationship emerges, in medical jurisprudence as against practice by medical practitioners. ⋯ Where abortion is performed, the question whether the husband has any right to prevent his wife from having a lawful abortion is discussed in the local context. Some thoughts on the medical (therapy, education and research) Act 1972 are expressed in relation to the living body, the corpse and the parts of the human body. The patient's right to determination and information in the light of the above legislation is also discussed.