Ann Acad Med Singap
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Hypoglycaemia in diabetes mellitus, occurring as a complication of treatment with insulin or oral hypoglycaemia drug therapy or spontaneously as a result of other medical conditions, is a frequent clinical problem. This paper will discuss the common causes of hypoglycaemia in diabetes mellitus, principles of treatment and prevention.
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Ann Acad Med Singap · Jan 1985
Case ReportsTreatment of acute deficits of moyamoya disease with verapamil.
A 7 year old girl with moyamoya disease presented with progressive right arm and leg weakness and muteness. Intravenous administration of verapamil was followed by immediate and lasting improvement in motor function and return of some expressive language. A second infusion of verapamil during angiography produced an increased opacification of collateral vessels in the left basal ganglia, suggesting drug-induced vasodilation and reversal of ischaemia as a mechanism for the observed clinical improvement. Calcium-channel blockers may be useful in the acute management of selected patients with moyamoya disease.
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Ann Acad Med Singap · Apr 1984
A quantitative evaluation of competing risks in occupational studies.
Mortality risk is competing because each individual is subject to several competing causes of death but can only die from one. Adjustment for competing risks will allow more meaningful comparisons of cause-specific mortality of two populations, especially if dying from all other causes is significantly different between the two populations. In this paper, a method has been developed for adjustment of competing causes of death in the calculation of relative risk. ⋯ Thus, the impact of competing risks is increased if the mortality risk of the study population is high, if the differential risk for all other causes is large or if wide age intervals are used in the mortality calculation. An example from refinery cohort data shows that in certain age groups unadjusted for competing risks the relative risk is overestimated by 9%. The impact of competing risks in this particular example is relatively small.
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Ann Acad Med Singap · Jan 1984
The surgical approach to recurrent pleomorphic adenoma of the parotid gland.
This is a retrospective study of 19 patients who were referred to the Department of Otolaryngology, Edinburgh Royal Infirmary with recurrent pleomorphic adenoma of the parotid gland. In the majority of patients, a superficial parotidectomy was performed as primary treatment. Recurrence of the tumour was either due to tumour implantation or inadequate surgical excision. ⋯ Change from pleomorphic adenoma at first operation to carcinoma in pleomorphic adenoma (malignant mixed tumour) at the second was noted in three patients who are still alive and free of recurrent tumour. Eighteen out of the 19 patients did not have further recurrences after revision parotidectomy. The surgical principles in the prevention of tumour recurrence and revision parotidectomy are discussed.
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Ann Acad Med Singap · Oct 1983
ReviewCurrent concepts of the pathogenesis and management of diabetic ketoacidosis (DKA).
Diabetic ketoacidosis (DKA) is the commonest endocrine emergency encountered in clinical practice. Although in the last 3 decades the average worldwide immediate mortality has decreased from 10% to 5%, survival has not improved strikingly. The pathogenesis of DKA is currently attributed to a combination of two hormonal abnormalities--a relative insulin insufficiency and stress hormone excess (glucagon, catecholamines, cortisol and growth hormone). ⋯ Current acceptable treatment of DKA include the following: adequate fluid replacement: low dose insulin therapy at frequent intervals; adequate potassium replacement from time of first insulin therapy with ECG monitoring; bicarbonate replacement if pH less than 7.1; broad spectrum antibiotics if infections is suspected and other supportive measures. The role of phosphate and magnesium replacement is still controversial. An awareness of the complications during the treatment of DKA including cerebral edema (paradoxical acidosis), altered central nervous system oxygenation, vascular thrombosis, shock, myocardial infarction, pancreatitis, infection, inhalation of vomitus , overhydration, underhydration , hypoglycaemia, hyperkalemia and hypokalemia all certainly help improve the morbidity and mortality of DKA.