Primary hepatocellular carcinoma associated with Wilson's disease in a young woman

A 27 year old woman with hepato-lenticular degeneration (Wilson's disease) was found to have primary hepatocellular carcinoma (PHC) three and a half years after she was started on treatment with D-penicillamine. The tumour was resected since when she has remained well. Her liver function tests were normal throughout the course of her disease. The available literature is reviewed and possible mechanisms for this association proposed.

Thyrotoxicosis, myasthenia gravis and periodic paralysis in a Chinese man

The association of myasthenia gravis and periodic paralysis in thyrotoxicosis has not been reported before. We describe a Chinese man with thyrotoxicosis and myasthenia gravis, who subsequently developed periodic paralysis. The possible aetiological links are discussed.

The influence of sex, race and dialect on peptic ulcer and non-ulcer dyspepsia in Singapore

A consecutive series of 2,277 patients presenting for upper gastrointestinal endoscopy was analysed. The following groups of patients were studied with reference to sex, race and dialect groups: those presenting with dyspepsia but no haemorrhage, those presenting with upper gastrointestinal haemorrhage, those with non-ulcer dyspepsia, gastric ulcer and duodenal ulcer. Males out-numbered females in all diagnostic groups. Male and female Malays were under-represented in all diagnostic groups when compared to the Singapore population. Amongst female Chinese, there was an excess of Cantonese patients and an under-representation of Teochew patients in most diagnostic groups. These dialect differences were not remarkable amongst male Chinese. The possible reasons for these differences and their significance are discussed.

The use of one gram daily cimetidine in the treatment of peptic ulcer in Singapore

An open study was conducted to assess the efficacy of Cimetidine one gram daily in the treatment of peptic ulcer amongst outpatients in Singapore. Forty patients with duodenal ulcer and fourteen patients with gastric ulcer were entered into the study. Ulcer healing was assessed by endoscopy. At six weeks 85% of duodenal ulcers and 64% of gastric ulcers healed. Although the study is uncontrolled the figures suggest that Cimetidine I gram daily is effective in the treatment of duodenal ulcer in Singapore outpatients. The efficacy of Cimetidine in gastric ulcer, however requires further study.

Hyperthyroidism with periodic paralysis, acropachy, pre-tibial myxoedema, transient atrial fibrillation and myopathy

A case of thyrotoxicosis presenting with periodic paralysis and later complicated by acropachy, pretibial myxoedema and transient atrial fibrillation is described. This association has not been reported previously. Possible aetiological links are discussed.