[Meniscus plasty of the discoid cartilage of the knee joint. Report of 32 cases].

During the time period from 1982 to 1987, 32 patients, 17 females and 15 males, aging 14 to 47, had their lateral discoid menisci reshaped operatively into nearly normal configuration. Final results of the treatment were both subjectively and objectively satisfactory confirmed at the time of re-examinations, 3 to 48 months (25 pts. had been over one year) after operation. Reshaping the discoid meniscus not only brought about normal pattern of it, got rid of symptoms and signs caused by the discoid meniscus-itself, but also by eliminating the horizontal shearing force produced by non-physiological motion of the discoid meniscus, reasonably prevent, at least delay the development of osteoarthritis of that joint.

Treatment of irresectible hepatocellular carcinoma with intrahepatic arterial lipoidal mixed with adriamycin and mitomycin C.

Four patients with advanced hepatocellular carcinoma, but with stage I functional disease, were treated with intrahepatic arterial lipoidal mixed with small doses of Adriamycin (20 mg) and Mitomycin C (10 mg). Regression was seen in 3 out of the 4 patients. In 2 patients, there was substantial regression of tumour clinically, radiologically and biochemically. The treatment was tolerable without marrow depression or deterioration of liver function. Mild fever (37 degrees C) was seen in 2 and epigastric pain in 1. This form of treatment opens up scope for further improvement in the management of irresectable hepatocellular carcinoma.

Post-abortion insertion of MLCu 250 and MLCu 375--a comparative trial.

This randomized prospective trial compared the use effectiveness and side effects of the MLCu 250 and MLCu 375 inserted immediately post-abortion. Five-hundred-and-forty-nine patients were followed-up over a two-year period involving 9890 woman-months of use with a loss to follow-up rate of only 5.1%. Both IUDs gave good protection against pregnancy (gross rates at 24 months, 1.8 and 2.1). There were no significant differences between the two devices in pregnancies or other termination events.

The use of bromocriptine in hyperprolactinemia and galactorrhea in Singapore.

Ninety-four women and seven men were treated with low dose bromocriptine for (a) hyperprolactinemia or (b) normoprolactinemia but with galactorrhea and a pituitary adenoma. All the pituitary adenomas became smaller or remained the same. Prolactin levels decreased with treatment and inappropriate galactorrhea improved in the 53 patients except for 7 where there was no change. Of the 41 women with premenstrual mastalgia 78% improved with treatment. Of the 74 women with ovulatory problems, a biphasic pattern was restored in 65 patients. Thirty-two patients out of the 92 trying to conceive achieved a pregnancy with an abortion rate of 12.5% and non-lethal congenital abnormality of 9.8% (2.1% in Singapore population). Fertility was restored in 3 hyperprolactinemic oligospermic males and improved libido was professed by most of the treated men. Side effects were present but were on the whole tolerable. Pregnancy rate was better in those with high levels of prolactin (greater than 1000 miU/l) than in those with hyperprolactinemia of between 500 and 1000 miU/l although this was not statistically significant chi 2 = 0.69. In the lower hyperprolactinemic range there was noticeable number of patients with endometriosis and increased luteinizing hormone (LH) levels.

Combined team management of diabetes mellitus in pregnancy.

225 women with diabetes in pregnancy were managed by a team of obstetricians, physicians (endocrinologists) and paediatricians from the National University of Singapore. A protocol of management was formulated and followed. The incidence of 1.1% or 1 in 90 pregnancies was found, with significantly higher incidence in Indians and lower in Malays. There were 37 established diabetics and 188 diagnosed during pregnancy. Of these (188), 74 were gestational diabetics. All the women were treated with Insulin and Diet or Diet alone. 177 (79%) were treated with Insulin and Diet. Blood sugar profiles were done for monitoring diabetic control. 72.8% of the women were between para 0 and 1 and 85.2% between the ages of 20 and 34. 72.5% of the women delivered at 38 weeks gestation or later. 48.9% went into spontaneous labour, 32.4% were induced and 18.7% had elective caesarean section. 62.2% of the women had labour of less than 12 hours. The overall caesarean section rate was 41.7%. There were 3 stillbirths and 2 neonatal deaths. The perinatal mortality rate was 2.2%. Thirteen babies had congenital malformations (5.8%). 77.8% of the babies had Apgar score of 7 or more at 5 minutes after delivery. 79.1% of the babies weighed between 2.5 kgm and 3.9 kgm. Pre-eclamptic toxaemia was the commonest complication in pregnancy followed by Urinary Tract Infection and Polyhydramnios. Postpartum complications in the mother were confined to 14 women (6.2%), and wound infection or breakdown was the commonest cause.

Long-term effects of Depo-Provera on carbohydrate and lipid metabolism.

Long-term effects of injection Depo-Provera (depo-medroxyprogesterone acetate) on carbohydrate and lipid metabolism were studied in 157 women who were treated continuously for a mean duration of 43.3 months. The patients were matched with 162 controls for race, age, parity and height. Glucose tolerance was impaired with higher intolerance at longer duration. Glucose areas were significantly higher at 48 and 60 months of injection. Insulin levels were also significantly decreased at 30 minutes and increased at 150 minutes but the area was normal. Triglycerides were initially decreased, being significant at 36 months (p less than 0.001) and returned to normal at 60 months while cholesterols were significantly higher at 24 and 36 months (p less than 0.05) and 60 months (p less than 0.001). In view of these findings, Depo-Provera may have an advantage over oral pills on a short term basis as there are less alterations in carbohydrate and lipid metabolism.

The acceptability of the Copper 7, Multiload 250 and Copper T 220C intrauterine devices.

PIP: 1725 patients were recruited for a prospective, randomized, comparative study of 3 IUDs: the Gravigard (Cu 7), Copper T 220C (T Cu 220C), and the Multiload 250 (ML Cu 250). All 3 devices were acceptable to patients with a continuation rate of over 60% at 2 years. The rates for accidental pregnancy and expulsion at 2 years were significantly higher for the Cu 7 when compared with the ML Cu 250 (P0.05) and the T Cu 220C (P0.01). Use-related terminations were more common with the Cu 7 than the ML Cu 250 (P0.05). All but 1 of the physicians questioned felt that the ML Cu 250 gave the least problems at insertion.^ieng

Comparative studies of IUDs in Singapore.

PIP: 3 IUD studies were performed by the University Dept. of Obstetrics and Gynecology, Kandang Kerbau Hospital, Singapore, between 1974-80. The IUDs used were the Cu T 220C, Cu 7, Latex Leaf, Dalkon Shield, Multiload (ML) Cu 250, and the ML Cu 375 and were used on 1992 patients over 34,023 woman-months of use. At 24 months, the Dalkon Shield had a significantly higher accidental pregnancy rate when compared with the Cu 7 (P0.05) and the ML Cu 250 (P0.05). The Cu 7 users had a significantly higher expulsion rate than users of the Latex Leaf (P0.001), ML Cu 250 (P0.001), and Dalkon Shield (P0.01). The Cu 7 had a significantly higher accidental pregnancy rate when compared with the Cu T 220C (P0.001) and ML Cu 250 (P0.05). The Cu T 220C also had a significantly higher expulsion rate when compared with the ML Cu 250 (P0.05). A comparison between the ML Cu 250 and ML Cu 375 showed no significant differences between the 2 devices.^ieng

Risk factors for screening potential diabetics in pregnant Chinese patients.

An intensive screening programme for potential diabetics in pregnancy was conducted in the University Department of Obstetrics and Gynaecology, Kandang Kerbau Hospital, Singapore, from June 1978 to December 1980. All patients with one or more risk factors for potential diabetes underwent an oral glucose tolerance tests (OGTT) with 50 g glucose loads. An abnormal OGTT was defined as one in which the second hour venous plasma glucose value was 7.8 mmol/1 (140 mg%) or more. In a group of 789 Chinese patients aged between 20 and 40 years, the overall detection rate of abnormal OGTTs was 15.5%. A significantly high proportion of abnormal OGTTs was found in patients with a direct family history of diabetes associated with random glycosuria during pregnancy and those with a previous history of 2 or more consecutive spontaneous abortions. However, in view of the relatively low detection rate of abnormal OGTTs in pregnant potential diabetics, a preliminary blood screening test would be useful to select those patients who require full OGTTs.