Singap Med J
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Metastatic disease of colon and rectal carcinoma accounts for a high proportion of cancer related deaths. The common organs involved in metastatic diseases include liver, lung, brain and bone. Although, theoretically possible, metastasis to the other organs are rare. We report the first case of carcinoma of the rectum with a solitary metastasis to the glans penis.
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Torsade de Pointes (Tdp) is a form of polymorphic ventricular tachycardia in the setting of prolonged QT interval. Any drug that prolongs repolarisation, and hence QT interval, may cause Tdp. Predisposing factors of drug-induced Tdp include female sex, bradyarrhythmia and hypokalaemia. ⋯ Tdp is a potentially life-threatening arrhythmia. The list of torsadogenic drugs is ever expanding. Physicians need to know the drugs which can lead to Tdp. Careful assessment of risk-benefit ratio is important before prescribing such drugs. Amiodarone-induced Tdp is not uncommon in our local population. Initiation of a class III agent, especially amiodarone, should be done judiciously, with monitoring of the QT interval and avoidance of hypokalaemia.
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Multicenter Study
A window on the current status of diabetes mellitus in Singapore--the Diabcare-Singapore 1998 study.
The Diabcare-Singapore project was carried out in 22 clinics (general hospitals, GH and primary healthcare centres, PHC) to provide an overview of diabetes management and metabolic control status. Data from 1697 diabetic patients were collected on paper forms and analysed centrally. Type 2 diabetes mellitus patients constituted 91.4% and type I patients constituted 8.1% of population. ⋯ Sixteen percent of patients had abnormal levels of protein (>500 mg/24 h) in the urine, 3% had elevated serum creatinine levels and 36% had microalbuminuria. Retinopathy (12%), cataract (16%) and neuropathy (12%) were commonly reported diabetic complications. The data revealed suboptimal glycaemic control in about half of patients studied.
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This study seeks to determine the prevalence of psychiatric morbidity within a medical intensive care unit, examine its correlation with the various physiological parameters and delineate any clinical predictors for psychiatric morbidity. Seventy-seven patients who gave informed consent were administered the General Health Questionnaire (GHQ), Acute Physiological And Chronic Health Evaluation II (APACHE II) and thyroid function tests were performed. ⋯ However, no statistically significant association was found between psychiatric morbidity and gender, age, APACHE II scores and thyroid function indices. Nevertheless, it is hoped that the index of suspicion for psychiatric morbidity can be raised in order to optimise the clinical management of patients within this setting.
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Review Case Reports
Cervical cord injury in an elderly man with a fused spine--a case report.
We report a case of an elderly man presenting with co-existing diffuse idiopathic skeletal hyperostosis (DISH) and ossified posterior longitudinal ligament (OPLL) resulting in central cord syndrome. Only three such cases have been reported co-existing with DISH. The patient recovered most of his neurological deficit through conservative management. A discussion on the radiological features of DISH co-existing with OPLL and how these differ from ankylosing spondylitis (AS) follows.