2005

KC Loh, L Pinheiro, KS Ng
Correspondence: Dr Loh Keh Chuan, lohkc@endocrinology.com.sg

ABSTRACT
A 35-year-old Chinese man presented with acute thyrotoxic periodic paralysis complicated by near-fatal cardiac arrhythmias due to persistent hypokalaemia, despite maximum potassium supplementation. He was eventually resuscitated with external cadioversion. In this unusual case of severe refractory hypokalaemia leading to ventricular fibrillation in a patient with underlying thyrotoxicosis, the potential dangers concerning the use of dextrose infusion and beta-adrenergic agent for resuscitation are highlighted.

Keywords: hypokalaemia, thyrotoxicosis, thyrotoxic periodic paralysis, ventricular fibrillation
Singapore Med J 2005; 46(2): 88-89

ATA Nandhini, V Thirunavukkarasu, MK Ravichandran, CV Anuradha
Correspondence: Dr Carani Venkatraman Anuradha, cvaradha@hotmail.com

ABSTRACT
Introduction The present study was designed to investigate whether taurine mitigates fructose-induced oxidative stress in rat tissues such as heart and kidney.
Methods Male Wistar rats of body weight 170-190 g were divided into four groups containing six rats each. Control animals received the control diet containing starch while fructose-fed animals received a fructose-enriched diet (greater than 60 percent of total calories). Fructose and taurine rats received the fructose diet and two percent taurine solution to drink. Control and taurine rats received the control diet and two percent taurine solution. After the treatment period of 30 days, insulin resistance index, by homeostasis model assessment (HOMA) was determined. The levels of lipid peroxidation markers, the enzymatic and non-enzymatic antioxidants status in heart and kidney tissues were measured.
Results Fructose rats showed high values of HOMA, increased lipid peroxidation and impaired antioxidant status. Taurine treatment to fructose rats attenuated the increased lipid peroxidation, enhanced the levels of antioxidants and improved insulin sensitivity.
Conclusion Inhibition of peroxidation markers and upregulation of antioxidant activity in rat tissues by taurine signify the potential utility of taurine as an adjunct in treatment of insulin resistance.

Keywords: antioxidants, fructose diet, insulin, lipid peroxidation, taurine
Singapore Med J 2005; 46(2): 82-87

M Rajadurai, PSM Prince
Correspondence: Dr P Stanely Mainzen Prince, p_smprince@yahoo.co.in

ABSTRACT
Introduction We demonstrate the effect of Aegle marmelos leaf extract (AMLEt) and alpha-tocopherol on plasma lipids, lipid peroxides and marker enzymes in rats with isoproterenol (ISO)-induced myocardial infarction.
Methods Rats were pre-treated orally for 35 days with different doses of an aqueous AMLEt (50 mg/ kg, 100 mg/kg and 200 mg/kg) prior to ISO-induced myocardial infarction. The effects on creatine kinase, lactate dehydrogenase, plasma thiobarbituric acid reactive substances, lipid hydroperoxides, serum lipids and lipoproteins were studied.
Results Pre-treatment with AMLEt at doses of 100 mg/kg and 200 mg/kg bodyweight for 35 days showed a significant effect on the activities of marker enzymes, lipid peroxides, lipids, lipoproteins and antioxidant enzymes in ISO-treated rats. The effect of AMLEt 200 mg/kg was found to be equal to the effect of alpha-tocopherol 60 mg/kg.
Conclusion Aegle marmelos leaves possess antihyperlipidaemic effect in rats with ISO-induced myocardial infarction.

Keywords: Aegle marmelos, isoproterenol, lipids, lipoproteins, myocardial infarction
Singapore Med J 2005; 46(2): 78-81

V Hufana, JSH Tan, KK Tan
Correspondence: Dr Tan Siah Heng James, siah_heng_tan@nni.com.sg

ABSTRACT
Introduction Although spinal tumours are amenable to total surgical excision, the factors determining the outcome are diverse. This study re-evaluates aspects of the disease that contribute to their outcome.
Methods Ninety-three consecutive patients with spinal cord tumours that underwent microsurgical excision between February 1992 and February 2002 were retrospectively studied. All patients underwent magnetic resonance imaging and had histological confirmation of spinal tumours.
Results There were 44 men and 49 women with a mean age of 49.05 years (range 6 to 83 years). The location of the tumours was cervical in 37 cases, thoracic in 41 cases, lumbosacral in 13 cases, and multilevel in two cases. The mean tumour size was 2.2 cm (range 0.8 to 7 cm) and mean duration of symptoms was 10.8 months. Complete excision was achieved in 72 cases and incomplete removal in 15 cases. The mean follow-up period was 21.45 months (range 3 days to 8 years). Immediate post-operative improvement was noted in 40 (43 percent) patients, 24 (25.4 percent) improved within six months, 13 (14 percent) improved after six months, 12 (12.9 percent) had no improvement and four patients died. The duration of symptoms and the completeness of excision were factors that correlated with post-operative improvement (p-value is less than 0.05). Age, gender, size, histological type, presenting symptoms, spinal level affected and axial location of tumour did not correlate with the outcome.
Conclusion Microsurgical excision of spinal cord tumours is a safe and effective procedure, and post-operative outcome is correlated to duration of symptoms and the extent of tumour resection.

Keywords: primary spinal cord neoplasm, spinal cord neoplasms, spinal neoplasms, spinal surgery
Singapore Med J 2005; 46(2): 74-77

CL Foo, E Seow
Correspondence: Dr Chik-Loon Foo, chik_loon_foo@ttsh.com.sg

ABSTRACT
Introduction To investigate whether the profile of female victims of domestic violence in Singapore has changed over the past ten years.
Methods 163 female victims of domestic violence presenting to an emergency department in Singapore were surveyed. The survey included information on the victims' demographics, assault characteristics and knowledge of help services. The results were compared against a similar survey done locally ten years ago, which involved 233 victims.
Results There were no significant differences in the racial composition, marital status, weapon use and admission rates of victims ten years on. However, a significantly higher proportion of female victims in 2002 knew where to seek help, compared to a decade ago (50.9 percent versus 20.6 percent, p-value is less than 0.0001).
Conclusion The proportion of victims with an awareness of community and legal help services has more than doubled over the past ten years.

Keywords: assault, battered women, domestic violence
Singapore Med J 2005; 46(2): 69-73

TLW Lim, KH Tan, CS Tee, GSH Yeo
Correspondence: Dr Tan Kok Hian, khtan@kkh.com.sg

ABSTRACT
Introduction A stillbirth remains a distressing enigma to parents and clinicians alike as the cause often remains elusive. Few papers describe a protocol for the investigation of stillbirths. We evaluate the first obstetric events-based protocol designed for local use with an aim to adequately investigate stillbirths in a cost-effective manner.
Methods A prospective cohort study was performed on 61 stillbirths at KK Women's and Children's Hospital. There were a total of 16,980 births in the year 2000.
Results 37.7 percent of cases remained unexplained. There was protocol compliance in 51 cases (83.6 percent) with deviation in 10 cases (16.4 percent). The protocol helped to minimise costs in 18 cases (29.5 percent) as selected investigations were performed in view of obvious causes. The overall postmortem rate was 27.9 percent with the lowest rates in the Malay population.
Conclusion An obstetric events-based protocol allows clinicians to tailor their investigations easily and appropriately. It helps to provide optimal investigations and minimise unnecessary costs. It could be further fine-tuned by initiating detailed serum investigations only after delivery so as to exclude an obvious cause, like cord accidents, where full investigations are unnecessary.

Keywords: autopsy, obstetric protocol, placental biopsy, stillbirth
Singapore Med J 2005; 46(2): 63-68