Legionnaires' disease--report of Singapore's first local case

A previously healthy 27 year-old male plumber presented with six days of fever, nausea, vomiting, malaise and headache. The subsequent development of cough, dyspnoea and pleuritic pain coincided with the simultaneous development of progressive bilateral cavitary pneumonia with pleural effusion. Leucocytosis, thrombocytopenia, hyponatraemia, hypoalbuminaemia, hypophosphataemia and hypoxaemia were the main laboratory abnormalities. Clinical suspicion of Legionnaires' disease was confirmed by the presence of serum antibody to Legionella pneumophila (titre 1:512) by an indirect fluorescent antibody test. Treatment with erythromycin and rifampicin resulted in clinical recovery with minimal residual bilateral pleural effusion six months after presentation. This patient is the first to acquire Legionnaires' disease in Singapore.

Fast fraction haemoglobin (HbA1) in the assessment of diabetes control

The degree of control of 132 diabetic patients was assessed using historical data, urine glucose and blood glucose measurements. These were then related to HbA1, taken as the final arbiter of glycaemic control. Symptoms of hyperglycaemia and glycosuria were found to be not sensitive or specific indices of control, though symptomatic glycosuric patients tended to have higher HbA1. Fasting blood glucose correlated modestly with HbA1 (r = 0.60, p less than 0.001) but if used alone to determine degree of control, 21% and 9% of patients could be expected to be over or under assessed respectively. The assessment value of timed post-breakfast blood glucose applied only to 120 and 150 minutes post-breakfast blood glucose as they correlated well with HbA1 (r = 0.73, p less than 0.001 and r = 0.96, p less than 0.001 respectively). Clinically impression of degree of control based on a combination of historical data, urine glucose and blood glucose led to "undertreatment" in 41% and "overtreatment" in 27% of patients. The complementary value of a knowledge of HbA1 was thus highlighted.

Pyogenic hepatic abscess and diabetes mellitus--a probable association

Four patients with pyogenic hepatic abscesses are reported. There were three females and one male with an age range of 36-75 years. In all the cases, diabetes mellitus was associated. Confirmation of the abscesses was obtained by liver scanning or ultrasonography, or both. In one patient, the clinical course was complicated by sympathetic pericardial effusion with right heart failure. Two patients had percutaneous transhepatic drainage of the abscesses under fluoroscopy. All four patients eventually required laparotomy and open drainage of the abscesses. Diabetic control was achieved with insulin therapy. The common causative organism in all instances was the Klebsiella species. Three patients recovered. The remaining one developed hypotension post-operatively and died of brain-stem infarction and the hepato-renal syndrome.

Non-insulin-dependent diabetes: 10-year outcome in relation to initial response to diet and subsequent sulfonylurea therapy

Thirty-eight non-insulin-dependent diabetic patients within 130% of desirable body weight were given a 100-g oral glucose tolerance test (OGTT) at diagnosis and after at least 1 mo of dietary treatment with energy and carbohydrate restriction. Thirteen "responders" showed an improvement in fasting blood glucose, glucose tolerance, and insulin secretion, with near-normalization of plasma, lactate, pyruvate, free fatty acids, glycerol, and ketone bodies. There were no significant changes in the 25 "non-responders." The responders were, at diagnosis, heavier than the non-responders (75.5 versus 64.3 kg, P less than 0.01). Twenty non-responders subsequently completed a prospective controlled study of glibenclamide, chlorpropamide, and placebo lasting for 16 mo with OGTTs at the end of each 4-mo treatment phase. The results showed that there were no significant differences between the metabolic effects of glibenclamide and chlorpropamide. On active treatment, insulin levels rose coincident with a fall in fasting blood glucose and an improvement in glucose tolerance and near-normalization of plasma lactate, pyruvate, free fatty acids, glycerol, and ketone bodies, all of which relapsed to initial values after placebo. Ten years after the initial study, 29 of the original patients were traced and reviewed and the outcome related to their earlier tests. Twenty-two percent of the responders and 70% of the non-responders were now on insulin (P less than 0.02); the initial insulin response to OGTT at the end of the diet treatment was significantly lower in those subsequently treated with insulin (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Schistosoma japonicum-like eggs in the appendix of an inhabitant of Java, Indonesia. A case report

The second case of autochthonous Schistosoma japonicum-like infection in man from Indonesia is reported. An appendectomy was performed on a 34-year-old inhabitant of Java of Chinese heritage. Microscopic examination of the necrotic appendix revealed S. japonicum-like eggs in the mucosa, submucosa, muscularis, and serosa layers. There were many degenerated and mineralized eggs, some of which were within giant cells and/or surrounded by scar tissue.

Comparative effects of hyperosmolar urea administered by intra-amniotic, intravenous, and intraperitoneal routes in rhesus monkeys

Hypertonic urea solutions (58 per cent weight/volume) were injected rapidly into ten anesthetized rhesus monkeys at a dose of approximately 2 Gm. per kilogram by the intravenous, intraperitoneal, or intra-amniotic routes. An additional monkey received an intra-amniotic dose of 12.5 Gm. per kilogram. A tracer dose 14C-urea was included for measuring absorption and elimination. The following parameters were monitored before and for four hours after urea injection: arterial and cerebrospinal fluid pressures, heart and respiration rates, urine flow, and urea clearance. Serum electolytes, hematocrit and white count, and cumulative urea excretion were measured for one week. Monkeys were observed for three to six months after injection. At doses up to approximately twice the human dose (on a body weight basis) there were no urea-related deaths and no serious side effects noted in any of the experiments. These results support the suggestion that urea is a relatively safe hyperosmolar agent for inducing midtrimester abortions, especially with regard to inadvertent systemic injection.

Hydrocortisone and the concentration of choline in the plasma of rodents

Cortisone has been reported to reduce significantly the plasma choline concentration in dogs within 30 min after its injection. However, in the present experiments hydrocortisone had no effect on the plasma choline concentration of mice, guinea-pigs and rabbits. The protective effect of hydrocortisone against the toxic effects of hemicholinium in mice which was described previously cannot, therefore, be attributed to changes in the concentration of plasma choline.