Avoiding fracture of titanium screws.
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Biomedical subjects
Publications and source records attributed to T C Lim.
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Over the past 50 years, a variety of surgical procedures have been advocated for the treatment of operable breast cancer, ranging from local excision to supraradical mastectomy. Today, the surgical treatment of breast cancer remains highly contentious. We review the historical development of breast cancer surgery and analyse the available evidence supporting conservative procedures. We also express our opinions on the treatment of early breast cancer and illustrate the changing patterns of surgery with our experience at National University Hospital.
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Single-duct microdochectomy is described for use in patients with bloody or serosanguinous nipple discharge arising from a single duct in the breast. Because most such cases are caused by benign, intraductal papillomata, the technique used in removing the offending ductal system should be fully diagnostic, adequately therapeutic, and cosmetically acceptable. A technique is described that is used in 40 consecutive patients with good diagnostic, therapeutic, and cosmetic result. The procedure itself combines techniques and principles of plastic and reconstructive surgery such as minimal tissue trauma, use of anatomical tissue planes, bloodless-field surgery, and microdissection.
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From 1979 to 1985, 8 children with clinical and biochemical features of Reye's Syndrome developed acute renal failure. Within the same period, a total of 28 cases of Reye's Syndrome were admitted to the Paediatric Units of Singapore General Hospital. Six of them were females and 2 were males. The mean age at presentation was 28.4 months and the range was between 9 months to 47 months. Four of them died eventually. There appeared to be a correlation between the eventual outcome and severity of renal failure and neurological state of admission.
Sixty-one consecutive cases of ulcerative colitis from the Department of Medicine, Singapore General Hospital, over a 16-year period (1971 to 1986) were reviewed. Mean duration of follow-up was 35.9 months (range 2 months to 16 years). Fifty-one (83.6%) cases were diagnosed in the last 8 years. Sex ratio was almost equal (males 30, females 31) and mean age was 38.2 years. All racial groups were affected but a predilection among Indians (21.3%) was observed. At presentation, the disease was mild in 36 (59.0%), moderate in 14 (22.9%) and severe in 11 (18.1%) patients. Fifty-two (85.2%) patients had symptoms of at least one month's duration before presentation. The 3 commonest symptoms were haematochezia (95.1%), diarrhoea (95.1%) and mucoid stools (83.6%). Extraintestinal manifestations of disease such as backache (8.2%), peripheral arthritis (6.5%), iritis (6.5%) and liver disease (1.6%) were uncommon. Severe intestinal complications include toxic megacolon (1.6%), colonic perforation (1.6%) and massive gastrointestinal haemorrhage (1.6%). Haematological and biochemical indices at presentation generally reflected the activity and severity of disease. The disease was limited to the rectum and sigmoid colon in 12 (19.7%) patients, extended up to the splenic flexure in 16 (26.2%), up to the hepatic flexure in another 16 (26.2%) and involved the whole colon in 17 (27.9%). Pseudopolyposis was present in 13 (21.3%) patients. Of 49 patients: (a) 18 (36.7%) had remission and were relapse free subsequently (b) 14 (28.6%) had infrequent relapses (less than 3 x/year) (c) 3 (6.1%) had frequent relapses (greater than 3 x/year) (d) 10 (20.4%) had chronically active disease (e) 4 (8.2%) had a short fulminant course terminating in death.(ABSTRACT TRUNCATED AT 250 WORDS)
Hepatocellular carcinoma afflicts mainly Chinese Singaporeans 75/77 (97.4%), of which 71/77 (92.2%) of the patients are males. It is rare below the 3rd decade of life (1.3%), with the peak incidence occurring in the 5th to 7th decade of life (68.5%). Common presenting features are hepatomegaly (85.7%), jaundice (63.6%), and right hypochondrial pain (51.9%). Liver function tests were abnormal in 98.7%. Alpha-foetoprotein were positive in 61/77 (79.2%) of patients. Hepatitis B surface Antigen were positive in 43.75 (57.3%) of patients. Radiology and ultrasound studies demonstrated that 70.1% had lesions involving both lobes at diagnosis. Only 4/77 (5.1%) had surgical resections of the tumour. 50/65 (76.9%) died within six months of diagnosis, 11/65 (16.9%) survived for one year, 1/65 (1.5%) for 1 1/2 years, 1.65 (1.5%) for 2 years and 2/65 (3.0%) for more than 2 1/2 years; the longest survivor is still alive, at 4 1/2 years after diagnosis.
Scintigraphic methods for liquid and solid gastric emptying were utilised to study normal patterns in 21 volunteers. Of these, 19 had solid emptying studies and 14 had liquid emptying studies. The liquid study lasted 1/2 hour, while the solid study was for 1 hour. The gastric emptying half-time (T 1/2), as well as percentage retention at 15 minutes (liquids), and at 60 minutes (for solids) were noted. The time-activity curves were also corrected for tissue attenuation. Results indicated normal average liquid emptying T 1/2 to be 14.2 minutes, while that for solids was 116 minutes.
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