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Biomedical subjects

P H Lim

Publications and source records attributed to P H Lim.

14 recordsLinked to original sources
PubMed1992

Pulsed dye laser lithotripsy--the Toa Payoh Hospital experience.

We report our experience with pulsed dye laser lithotripsy in the treatment of 100 ureteric stones in 95 patients over a 14-month period from July 1989 to September 1990. The overall rate of successful stone fragmentation was 97%. There was a low incidence of minor complications--mild haematuria, ureteric colic and urinary tract infection; ureteric perforation occurred in only 3 patients, all of whom were successfully treated conservatively. Pulsed dye laser lithotripsy is a safe and effective mode of treatment for ureteric stones. Current indications for laser fragmentation of stones are ureteric stones, impacted pelviureteric junction stones and Steinstrasse.

Adult↗
PubMed1992

Urinary symptoms and urodynamic diagnosis of patients in one geriatric department.

Fifty five patients between 65 and 89 years old who had their urinary problems assessed by urodynamics study were reviewed. The most common urinary symptom among males was urge incontinence, while retention and urge incontinence occurred with equal frequency among females. The commonest cause of retention in males was bladder outlet obstruction, while atonic neurogenic bladder was the most common cause in females. Urge incontinence was strongly associated with an unstable bladder, small bladder volume and Parkinson's disease. Retention of urine, and an atonic neurogenic bladder strongly correlated with diabetes mellitus. Three patients (out of 31) with unstable bladders also had detrusor external sphincter dyssynergia. Of these, two had Parkinson's disease. Although three patients were thought to have stress incontinence after history and physical examination, only two had stress incontinence with detrusor instability on urodynamic studies. The last patient had atonic bladder with overflow.

Aged↗
PubMed1992

Erectile dysfunction in Singapore men: presentation, diagnosis, treatment and results.

Three hundred and thirteen new cases were seen in more than two years at the Sexual Dysfunction Clinic at the Division of Urology, Toa Payoh Hospital (TPH). Patients were assessed by history, clinical examination, psychological evaluation, hormonal and biochemical tests; special investigations such as monitoring of nocturnal penile tumescence, cavernosography, selective pudendal arteriography and tests of neurological function were performed where indicated. Two hundred and twenty-seven patients (72.5%) had impotence due to organic causes while 86 patients (27.5%) were found to have psychogenic impotence. Diabetes mellitus and vascular disease account for the large proportion of organic impotence (81%). Patients with psychogenic impotence responded fairly well to psychosexual therapy and drug treatment in certain cases. Forty-four patients underwent medical therapy which consisted mainly of pharmacologically induced penile erections by the use of papaverine, phentolamine or prostaglandin E-1; 21 patients (48%) who were on self-injection therapy became non-compliant subsequently. One hundred and fourteen andropausal patients with low testosterone levels received hormonal replacement. Thirty-one patients underwent surgery--stripping and ligation of the deep dorsal vein of the penis (13 patients), microsurgical arterial revascularisation (two patients) and penile prosthetic implantation (16 patients). Our success rates for the operations were 54%, 100% and 88% respectively.

Adult↗
PubMed1991

Protein-induced changes in energy expenditure in young and old individuals.

Resting energy expenditure (EE) has recently been shown to be reduced in elderly human subjects even after adjustment for body size and composition. The present study extended this examination of EE in relation to age by comparing the thermic effect of a protein meal in young men (YM 20-26 yr, n = 9), old men (OM 70-89 yr, n = 9), and old women (OW 67-75 yr, n = 6). EE was measured before and from 1 to 6 h after presentation of 60 g protein and of a control noncaloric meal on separate occasions. Despite substantial differences in body size and composition, the protein-induced increment in EE was similar in all groups [maximum increase: YM 0.21 +/- 0.05, OM 0.17 +/- 0.12, and OW 0.17 +/- 0.04 (SE) kcal/min]. Although fasting plasma norepinephrine (NE) levels differed among all three groups (YM less than OM less than OW), NE concentrations were not affected by protein ingestion. Because protein administration acutely promotes synthesis of dopamine (DA) and serotonin (5-HT), which are both capable of stimulating EE, blockade of extraneuronal synthesis of DA and 5-HT with carbidopa, a competitive inhibitor of aromatic-L-amino acid decarboxylase, failed to suppress (and actually increased) postprandial EE. These data demonstrate that not all mechanisms responsible for EE decline with age and that protein-induced changes in EE are more a function of the oral load itself than of the size, age, or antecedent diet of the individual ingesting the protein.

Adult↗
PubMed1991

Ureterorenoscopy: factors influencing success.

The first 100 patients with ureteric calculi to undergo planned ureteroscopy and lithotripsy were retrospectively studied to evaluate the factors which influenced the success of the procedure. All 75 males and 25 females who underwent this procedure had surgical indications to treat the stones. The factors influencing a successful outcome were studied over four different time frames. It was found that the procedure was more successful in females, and lower ureteric stones. The stone size did not affect the outcome as expected. The learning curve was very evident as increased experience produced higher success rates for ureteric access and lithotripsy, less morbidity, shorter operating time and lower open surgery rates. The introduction of the miniscope and laser lithotripsy was however the most significant factor in ensuring a successful outcome.

Adult↗
PubMed1991

Testicular biopsy and scrotal exploration in the management of male infertility.

Testicular biopsy findings in 52 subfertile men were correlated with the clinical findings, semen analyses and hormonal levels. Mild to moderate pathological changes were seen in 2/3 of cases while 1/3 had severe damage. Almost 3/4 of them had atrophic testicles while up to 1/2 had varicoceles. In most cases, routine examination, semen analyses and hormonal studies could not provide an accurate guide to the severity of the lesions. Size alone correlated well with worse changes in the smaller testes. Biopsy was more precise for assessing oligospermia and azoospermia in which the histology can vary considerably. The pattern with varicocele was not pathnognonomic but maturation arrest was common in younger patients while older men tend to have sclerosis and intraluminal sloughing irrespective of the grade of venous reflux. FSH and LH levels were only useful when either or both were raised more than 3 times. Normal FSH could be found in germinal aplasia or maturation arrest. In the latter, the testes were often of good size; thus diagnosis would not be made without biopsy. Examination of the testes, epididymis and the vasa was always done at the time of biopsy and when indicated, vasography helped elucidate the nature and site of the obstruction causing azoospermia. When a varicocele was present, biopsy of the testes at the time of ligation can provide assessment of the pathological change and provide a prognosis especially when additional hormonal treatment was being considered. The greatest value of biopsy was in cases confirmed beyond salvage by histology. This enabled appropriate action to be taken ie. AID or adoption, etc.

Adult↗
PubMed1990

The Burch Colposuspension operation for stress urinary incontinence.

One hundred and thirteen patients with genuine stress incontinence were treated by a modified Burch Colposuspension after having failed an adequate trial with medical management. Three-quarters of patients were evaluated with pre-operative video-cystometry (video-C.M.G.) while a third underwent post-operative video-cystometry. Flow rates were generally lower after surgery with 3 of the 113 patients developing post-surgery bladder instability. Previous incontinence surgery and higher parity produced statistically a greater number of failures. The overall subjective success of the operation was 80% with another 12% improved at 2 years. A 5 year long-term questionnaire follow-up did not demonstrate marked changes in these figures. The operation itself carries a 16% incidence of significant early complications, while late complications totalled 23%, the latter being primarily minor conditions. Patients left hospital after an average of 10 days.

Adult↗
PubMed1990

Computer application in a general practice.

Computer application in General Practice has improved the standard of healthcare. Computers have been used in the clinic for general administration and accounting. A Clinic Management System in addition can be used in most of the functions required in the running of a clinic. It will be able to generate useful data to help the doctors make sound decisions based on valid, up-to-date information. Communications and accessing of medical databases can be made available with a central network such as MediNet. There are currently no well developed medical record management systems suitable enough for implementation in general practice. Computerisation of the general practice will require careful planning and gradual implementation using a reliable application software backed by good support from the original developer. Commitment to continued research and development of the software will ensure that the implemented system will not be outdated.

Ambulatory Care Information Systems↗
PubMed1989

Initial management of acute urethral injuries.

A study was made of 30 cases of acute urethral trauma treated over a 7-year period. There were 10 anterior and 20 posterior urethral injuries, the majority of these being partial ruptures. Posterior urethral injuries were caused by road traffic accidents in 75% of cases while 80% of the anterior urethral injuries were of the "straddle" type. There was only 1 case of iatrogenic injury to the anterior urethra. During follow-up, all patients required periodic dilatations for stricture except for the single case of iatrogenic injury. An average of 5 dilatations controlled all of the strictures except for 2 that required urethroplasties.

Adult↗
PubMed1988

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. Half of the study population developed some form of post-operative complication and nearly one quarter died. Of the ten nutritional markers studied, only serum transferrin had predictive value in determining post-operative outcome. The mean level of serum transferrin for patients with major complications was 162.0 mg/dl as compared with 221.2 mg/dl for those with none or minor complications. Patients with a serum transferrin level below the reference range of 200 mg/dl had most of the major life threatening complications and deaths. The other nutritional markers studied did not correlate well with post-operative outcome. 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.

Female↗
PubMed1977

Purification and characterization of CTP: cholinephosphate cytidylytransferase from rat liver cytosol.

Two forms of CTP:cholinephosphate cytidylyltransferase have been identified in the cytosol of rat liver. The L-form has a molecular weight of about 2.0 X 10(5) and low specific activity. The activity of the L-form is markedly stimulated by liposomes made from rat liver lipids. The L-form is the major species present in fresh cytosol. When the cytosol is incubated at 4 degrees for 5 days, the H-form (high molecular weight) of the enzyme is generated from the L-form. The H-form consists of multiple copies of the L-form and requires a lipid-containing fraction for optimal activity. The H-form has a wide range of molecular weights with a median value of 1.3 X 10(6). It was possible to dissociate partially the H-form of the enzyme into the L-form by incubation with 0.05% sodium dodecyl sulfate. The H-form of the enzyme could be generated by incubation of the L-form with liposomes. The L-form of the cytidylyltransferase was purified from rat liver cytosol. The enzyme gave a single band when stained for protein or assayed for activity after polyacrylamide gel electrophoresis. Both forms of the enzyme were active over a wide range of pH with an optimum at pH 7.0. The K'c (pH 6.4) was 0.80. The true Michaelis constants for the forward and reverse reactions of both forms of the enzyme are given. The H-form of the enzyme from the cytosol could be precipitated by centrifugation at 100,000 X g for 1 h.

Aging↗