Original Article
Epidemiological trends and outcomes of children with aural foreign bodies in Singapore
Aural foreign bodies (FBs) commonly present to the emergency department (ED) worldwide. Children represent the majority of the population, believed to be due to...
Review Article
Determinants of emergency department utilisation by older adults in Singapore: A systematic review
Older adults in Singapore contribute to a disproportionately higher number of visits to the emergency department (ED), mirroring trends around the world.1,2 For instance,...
Original Article
Identifying high-risk hospitalised chronic kidney disease patient using electronic health records for serious illness conversation
In-hospital cardiopulmonary resuscitation (CPR) for chronic kidney disease (CKD) patients is shown to have lower survival1 and a higher proportion of survivors on maintenance...
Original Article
Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial
Critically ill patients in the emergency department (ED) have shorter safe apnoea times due to physiological distress from decreased cardiac output, increased shunting and...
Others
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy.
This...
Original Article
A Review of Pedestrian Fatalities in Singapore from 1990 to 1994
Fatal road accidents are by no means uncommon in Singapore, a modern tropical metropolis with a population of approximately 3 million. Statistics provided by...
Original Article
The Profile of Hospitalised Patients with Parkinson’s Disease
Prevalence studies in various parts of the world have shown that Parkinson’s disease (PD) is relatively common among the aged in all countries. Crude...
Others
Adjuvant Chemotherapy for Patients with Resected Dukes’ C and High-risk B2 Colon Cancer with Fluorouracil and Levamisole
Carcinoma of the large bowel is the second leading cause of cancer mortality in Singapore. Although the great majority of patients are discovered at...
Commentary
Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer
Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is...
Commentary
Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia
The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix....
Commentary
The Polarprobe—Emerging Technology for Cervical Cancer Screening
Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over...
Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.
This article is...
Others
Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case
A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians.
This article is...
Others
Pelvic Spleen Masquerading as an Ovarian Neoplasm
A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular...
Others
A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer
To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer.
This article...
Review Article
Optimal Treatment in Gestational Trophoblastic Disease
Gestational trophoblastic diseases (GTD) encompass a spectrum of interrelated conditions:
Hydatidiform mole (HM)
Invasive mole (IM)
Choriocarcinoma (CC)
Placental site trophoblastic tumour (PSTT)
This article is available only as...
Review Article
Fallopian Tube Carcinoma—A Review
Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847.
This article is available only as a...
Review Article
Current Management of Early Vulvar Cancer
Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although...
Review Article
Topoisomerase-I Inhibitors in Gynaecologic Tumours
Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been...
Review Article
Screening for Ovarian Cancer
Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the...
Review Article
Biomarkers in Carcinoma of the Cervix: Emphasis on Tissue-related Factors and Their Potential Prognostic Factors
Accurate staging is of utmost importance in determining the prognosis of carcinoma of the cervix. Demographic features such as race and socio-economic status have...
Review Article
The Management Dilemma of the Mildly Abnormal Smear: Fact or Fiction?
Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women...
Review Article
Adenocarcinoma of the Cervix
It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the...
Original Article
Malignant Ovarian Germ Cell Tumours: Experience in the National University Hospital of Singapore
One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some...
Original Article
A Phase II Study of Combined CPT-11 and Mitomycin-C in Platinum Refractory Clear Cell and Mucinous Ovarian Carcinoma
Platinum resistance, either de novo or acquired, is a major obstacle in the treatment of advanced ovarian cancer. Platinum-resistance has been classified into the...
Original Article
Single Agent Paclitaxel in Resistant and Relapsed Epithelial Ovarian Cancer After First-line Platinum-based Chemotherapy—Experience in an Asian Population
Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In...
Original Article
Uterine Papillary Serous Carcinoma—The KK Hospital Experience
Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing...
Original Article
Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients
Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control...
Original Article
Outcome of Obstructive Uropathy After Pelvic Irradiation in Patients with Carcinoma of the Uterine Cervix
Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at...
Original Article
The Surgical Management of Colorectal Complications from Irradiation for Carcinoma of the Cervix
Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma...
Original Article
Adjuvant Chemotherapy in “High Risk” Patients after Wertheim Hysterectomy—10-year Survivals
Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients...
Original Article
A Review of Patients with High-risk Carcinoma of the Cervix Treated with Combined Surgery and Postoperative Radiotherapy
It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness...
Original Article
Outcome of Early Cervical Carcinoma Treated by Wertheim Hysterectomy with Selective Postoperative Radiotherapy
Cancer of the cervix is the fourth most common cancer in females in Singapore after breast, colorectal and lung cancers. It forms 7.8% of...
Editorial
Gynaecologic Oncology—The Next Lap
Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all...
Original Article
Serum Selenium in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...
Original Article
Patients Admitted to an Intensive Care Unit for Poisoning
The study of poisoning has been relatively neglected in Singapore. A check through the Infogate database of the National University of Singapore Library revealed...
Original Article
Survival after Cardiopulmonary Resuscitation in the General Wards—The Results of a Dedicated “Code” Team
Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...
Original Article
Plasma Vitamins A, C and E in the General Population of Singapore, 1993 to 1995
The current disease pattern in Singapore (an island state of 3.3 million people composed of 76% Chinese, 14% Malays, 7% Asian Indians and 3%...
Original Article
Concurrent Chemoradiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma of the Undifferentiated Type
Nasopharyngeal carcinoma (NPC) of the undifferentiated type has a unique geographic distribution and is rather different, biologically and aetiologically, from squamous cell cancer of...
Review Article
Cancer Gene Therapy—Fantasy or Foresight?
Genes define life, at least in its biological sense. The prospect of being able to manipulate human biological processes through genetic engineering understandably evokes...
Original Article
A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens
Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been...
Original Article
Hospitalised Low-risk Community-acquired Pneumonia: Outcome and Potential for Cost-savings
Community-acquired pneumonia (CAP) is a common illness with nearly 4 million adults diagnosed each year in USA with more than 600,000 hospita1isations. The associated...
Others
3rd Yahya Cohen Lecture: The Role of the Myofibroblast-Like Cell in Hepatocellular Carcinoma—Host Defence?
It is indeed a great honour for me to be named the third Yahya Cohen lecturer and I would like to express my deepest...
Others
1998 Runme Shaw Memorial Lecture: Somatic Evolution of Cancer
The interpretation of cancer as a somatic evolutionary process involving genetic mutation followed by selection, goes back to the early years of this century....
Review Article
Prognostic Factors in Endometrial Carcinoma
In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of...
Original Article
Continuous Infusion 5-fluorouracil as Salvage Chemotherapy in Patients with Advanced Colorectal Cancer
Studies have shown beyond doubt that chemotherapy for metastatic colorectal cancer prolongs survival, impedes progression and stabilises disease. Compared with supportive care alone, it...
Original Article
Extent and Appropriateness of Emergency Department Services Usage by Foreign Workers in Singapore
Singapore employs more than 350,000 foreign workers currently. With this influx of foreign workers into our city-state which has limited land and resources, it...
Original Article
Drowning and Near-drowning—Some Lessons Learnt
Drowning is defined as suffocation from submersion in a liquid with death within the first twenty-four hours. Near-drowning implies that recovery has occurred, at...
Commentary
Effect of Antiangiogenic Agents on Experimental Animal Models of Hepatocellular Carcinoma
Metastatic spread is the principal reason of treatment failure in solid tumours. Surgery, radiation therapy and chemotherapy have not manifestly altered the prognosis for...
Review Article
Murine Metastatic Tumour Models for Cancer Gene Therapy Research
In the evaluation of any new cancer treatment, the use of appropriate experimental animal tumour models to bridge the gap between in vitro discovery...
Original Article
An Animal Model for the Study of Hepatic Stellate Cell and Hepatocellular Carcinoma Interaction
Hepatic stellate cells (HSC) are mesenchymal cells that are prominent in various forms of liver injury, in particular with cirrhosis or carbon tetrachloride-induced fibrosis....
Original Article
Synergistic Effect of Hepatitis B Virus and Aflatoxin B1 in Hepatocarcinogenesis in Tree Shrews
Primary hepatocellular carcinoma (HCC) is one of the commonest cancers in some parts of the world including several areas in China. The geographically distinct...
Original Article
The Expression of Insulin-like Growth Factor II, Hepatitis B Virus X Antigen and p21 in Experimental Hepatocarcinogenesis in Tree Shrews
Hepatocarcinogenesis is a multistage and multifunctional process. Epidemiological studies indicate that contamination of food with aflatoxin B, (AFB,) and chronic infection with hepatitis B...
Original Article
Extended Resection of Locally Advanced (T4) Stomach Cancer
Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years,...
Others
Design of Phase I and II Clinical Trials in Oncology and Ethical Issues Involved
Drug development is costly and time-consuming in terms of economic, patient and research resources. An integrated effort involving academia, industry, and regulatory authorities is...
Original Article
Spectrum of Abnormal Mammographic Findings and Their Predictive Value for Malignancy in Singaporean Women from a Population Screening Trial
While screening mammography can detect early breast cancers, a significant proportion of asymptomatic women are subject to unnecessary workup and surgery when biopsies for...
Others
Hereditary Breast Cancer: A Brief Overview
Worldwide, breast cancer is the third most common form of cancer, after lung and stomach cancer, and it is the most common form among...
Others
Update of Genetics in Colorectal Carcinomas: Genomic Instability and Somatic Evolution
The hypothesis that carcinogenesis occurs through stepwise accumulation of mutations1 has now been generally accepted. However, there is continual dispute over how carcinogenesis can...
Others
Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report
Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of...
Others
Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report
Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000...
Commentary
Preparing for the silver boom: A falls prevention tool for older adults in the emergency department
Each year, 28–35% of community dwelling adults over 65 years fall.1 This figure increases to about 50% for those above 80 years old.2 Falls...
Others
Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding
Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in...
Others
Two Cases of Medullary Thyroid Carcinoma
A 44-year-old Indian man was found to have a raised carcinoembryonic antigen (CEA) (49.5 μg/L) detected on routine medical examination in February 2000....
Original Article
Critical Role of Functional Decline in Delayed Discharge from an Acute Geriatric Unit
In the last decade, many countries have experienced alarming transformation in their demographic patterns, with the elderly population emerging as the fastest growing segment...
Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...
Others
Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series
Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours.
This...
Others
A Case of Alpha-Fetoprotein-Producing Gastric Cancer
A 57-year-old accountant presented to her doctors in a neighbouring country in early October 1998 with problems of easy bruising, bleeding gums, one single...
Others
Case Report: Acute Tumour Lysis Syndrome
Acute tumour lysis syndrome (ATLS) is one of the most urgent of all oncological treatment-related complications. It has a broad impact on organ dysfunction,...
Others
12th Chapter of Surgeons Lecture: Shifting Paradigms in the Management of Breast Cancer—A Surgical Perspective
The recorded history of breast cancer management spans four millennia. This story about breast cancer management is also one about change, about resistance to...
Review Article
CerbB2 Status in Breast Cancer: Pathologic Issues
The cerbB2 gene, also known as Her2/neu, encodes a transmembrane cell receptor with tyrosine kinase activity and epidermal growth factor receptor homology. All normal...
Original Article
Intravenous Adrenaline or Vasopressin in Sudden Cardiac Arrest: A Literature Review
Of the approximately 15,000 deaths that occur in Singapore every year, about 25% are from cardiac causes; of which, some 30% to 40% occur...
Original Article
Cancer Incidence in Singapore, 1998 to 1999
The Singapore Cancer Registry has been monitoring the trends in cancer incidence since 1968. It publishes 5-yearly incidence figures for the periods 1968-1972, 1973-1977,...
Original Article
Efficacy and Tolerability of Irinotecan in Patients with Advanced Colorectal Cancer in Singapore
Colorectal cancer is the second most commonly encountered malignancy in the developed countries; in Singapore, it is the commonest cancer. With early detection, patients...
Original Article
Audit of Total Parenteral Nutrition in an Adult Surgical Intensive Care
Total parenteral nutrition (TPN) may contribute to good outcome in selected groups of patients. Parenteral nutrition is highly effective in reversing effects attributable to...
Original Article
The Mastectomy Clinical Pathway: What Has It Achieved?
In an era of increasing healthcare cost and scarce resources, the tension between the cost and quality of healthcare demands not only effective but...
Others
Agreement or Prediction: Asking and Answering the Right Question
In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to...
Original Article
Acute Coronary Syndrome—Factors Causing Delayed Presentation at the Emergency Department
Acute coronary syndrome (ACS) refers to a continuum of clinical entities ranging from unstable angina pectoris (UAP) to Q-wave myocardial infarction. Mortality rates from...
Original Article
Preliminary Experience in Radionuclide Therapy of Hepatocellular Carcinoma Using Hepatic Intra-arterial Radio-conjugates
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. In Singapore, the age-standardised incidence rate is 18.9 per 100,000 per year.
This article is available only...
Original Article
The Acute Presentation of Pulmonary Thromboembolism: A Retrospective Viewpoint
Pulmonary thromboembolism (PE) has historically been considered a rarity in the Asian population. Although well studied in the West, Asian literature on this condition...
Original Article
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...
Original Article
Influenza in Singapore: Assessing the Burden of Illness in the Community
Influenza is a major cause of morbidity and mortality worldwide. Morbidity in the working age group gives rise to frequent doctor visits and considerable...
Letter to the Editor
Re: 188Rhenium-TDD-Lipiodol in Treatment of Inoperable Primary Hepatocellular Carcinoma—A Case Report
Hepatocellular carcinoma (HCC) is a common malignancy that is best treated by surgery. However, in the vast majority, surgery is not possible and alternative...
Others
Emergency Department Usage by Community Step-Down Facilities – Patterns and Recommendations
It is projected that elderly persons will make up 18.4% of Singapore’s population by the year 2030. Currently, there are 5189 residents staying in...
Others
Critically Ill Elderly Who Require Mechanical Ventilation: The Effects of Age on Survival Outcomes and Resource Utilisation in the Medical Intensive Care Unit of a General Hospital
Increasing life expectancy and ageing of the “post-war baby boomer” generation have led to the rapidly ageing demographic of many Asian countries. Singapore’s elderly...
Others
Carcinoma of the Cervix: Role of MR Imaging
In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each...
Review Article
Radionuclide Therapy of Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. It is a major cause of death from cancer in East Asia, especially China, Japan, Korea,...
Original Article
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of...
Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point....
Review Article
The Molecular Biology of Peritoneal Carcinomatosis from Gastrointestinal Cancer
The term “peritoneal carcinomatosis” was first used by Sampson in 1931 to describe the intra-abdominal spread of ovarian carcinoma. Although ovarian cancers account for...
Review Article
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
Colorectal cancer is the second most common cancer in Singapore, accounting for 15.9% of all cancers registered with the Singapore Cancer Registry in the...
Review Article
Neoadjuvant Chemotherapy in the Management of Colorectal Metastases: A Review of the Literature
Colorectal cancer accounts for the most number of deaths after lung cancer, both in the West as well as locally in Singapore. Liver is...
Original Article
Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience
Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy...
Original Article
Computed Tomographic Appearance of Colorectal Hepatic Metastases
It is important to recognise the computed tomography (CT) appearance of hepatic metastases from colorectal primaries, as resection in a selected group may offer...
Review Article
Current Status in Imaging of Colorectal Liver Metastases
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the...
Review Article
Current Concepts of Tumour Metastasis
Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor...
Review Article
Chemoprevention of Colorectal Cancer – Experimental Approach and Clinical Applications
The age-old adage of “Prevention is Better than Cure” is still very relevant in today’s practice of medicine. Many randomised population trials have already...
Review Article
Practical Issues in Adjuvant Therapy for Rectal Cancer
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Total Mesorectal Excision (TME) – Twenty Years On
In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing...
Original Article
Flat and Depressed Lesions of the Colon and Rectum: Pathogenesis and Clinical Management
It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal...
Others
Surgical Management of Colorectal Metastases to the Liver
Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver...
Editorial
Recent Advances in the Total Management of Colorectal Cancer
Considerable improvements in the survival and outcome of colorectal carcinoma have been made in recent years. These have been the result of advances in...
Others
Unusual Case of Bowel Infarction with Invasive Aspergillus in an Immunocompromised Patient
The role of neoadjuvant chemotherapy for locally advanced breast cancer has been established and there has been a growing interest in its role in...
Review Article
Art and “the Language of Well-Being” in Adolescent Health Care
Creative processes involve imagining, making unexpected connections, maintaining discipline while letting go of controlling the outcome, opening oneself to pleasure, and moving beyond frustration....
Letter to the Editor
Stress among emergency medicine residents during the COVID-19 pandemic: A qualitative study
Dear Editor,
The COVID-19 pandemic has disrupted medical education1,2 and distressed clinicians.3,4 Understanding the impact of this pandemic on emergency medicine (EM) residents’ experience of...
Original Article
The HercepTest and Routine C-erbB2 Immunohistochemistry in Breast Cancer: Any Difference?
The proto-oncogene c-erbB2 (also known as HER2/neu) is located on chromosome 17q21 and encodes a 185-kD transmembrane glycoprotein. It belongs to the human epidermal...
Others
A Case of Metastatic Squamous Cell Carcinoma of the Hypopharynx Manifesting as Acute Abdomen
T, a 23-year-old female, was previously well until November 2000 when she presented with 1-year history of sore throat associated with neck lumps for...
Others
A Case of Maffucci’s Syndrome With Pleural Effusion: Ten-year Follow-up
A 23-year-old male patient was admitted to Ataturk Chest Disease Hospital with non-productive cough, dyspnoea, chest pain and back pain. These complaints had begun...
Original Article
Work-related Injury Sustained by Foreign Workers in Singapore
Singapore has a resident population of 3.26 million and 0.53 million foreign workers. Of these half a million foreigners, 450,000 are work permit holders,...
Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...
Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...
Others
Two Case Reports of Metastases from Colon Carcinoma to the Thyroid
Metastases to the thyroid are not as rare as previously believed and have been shown, in autopsy series, to be more common than primary...
Original Article
Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population
Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically...
Original Article
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Radiofrequency (RF) ablation for the treatment of focal liver malignancies is a relatively new image-guided procedure that is gaining increasing acceptance in the radiologic...
Original Article
Detection and Quantification of the Abelson Tyrosine Kinase Domains of the bcr-abl Gene Translocation in Chronic Myeloid Leukaemia Using Genomic Quantitative Real-time Polymerase Chain Reaction
Chronic myeloid leukaemia (CML) is a clonal stem cell malignancy characterised by massive proliferation of mature and immature granulocytes, basophils and spleen cells, but...
Review Article
The Feminist Approach in the Decision-making Process for Treatment of Women With Breast Cancer
The ethical theories employed in healthcare today generally assume a modern Western philosophical framework, which is applied to many issues such as abortion, euthanasia,...
Others
Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum
Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with...
Others
Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report
Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in...
Others
Postirradiation Sarcoma of the Sphenoid Bone – A Case Report
Radiation-associated tumours of the temporal and maxillary bone have been reported in patients treated with radiotherapy for nasopharyngeal carcinoma. There was no previously reported...
Commentary
Clinical Cases Seen in Tsunami Hit Banda Aceh – From a Primary Health Care Perspective
Earthquakes and tsunamis can cause massive destruction over large areas, affecting the lives of many in areas hit by such disasters. The local health...
Original Article
Phase II Trial of Gemcitabine and Cisplatin Sequentially Administered in Asian Patients With Unresectable or Metastatic Non-small Cell Lung Cancer
Lung cancer is the most common cause of cancer-related death worldwide. It ranks first among males and third among females in the incidence of...
Others
Parathyroid Carcinoma: A Case Series
Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis,...
Images in Medicine
Putting Together Lesions in the Brain, Retina, Kidney and Pancreas
A 40-year-old Malay lady presented with a 6-month history of headache. She had a past history of a left nephrectomy 6 years ago.
This article...
Letter to the Editor
Tuberculosis Masquerading as Recurrent Metastatic Carcinoma of the Cervix
The incidences of certain malignancies are increasing and are major causes of mortality. Diagnosis can be difficult and delayed.
This article is available only as...
Review Article
Association of Epstein-Barr Virus with Nasopharyngeal Carcinoma and Current Status of Development of Cancer-derived Cell Lines
Although nasopharyngeal carcinoma (NPC) has been reported in almost all parts of the world, most cases of NPC are found in South East Asia,...
Original Article
Observational Study to Determine Factors Associated with Blood Sample Haemolysis in the Emergency Department
Haemolysis of blood samples leads to inaccurate results and often necessitates a repeat sample. Escalating workloads and finite resources are an increasing problem in...
Others
Review of Children Hospitalised for Ingestion and Poisoning at a Tertiary Centre
Childhood ingestion and poisoning is an important problem in many countries,1-8 and accounts for a significant workload for emergency department consultations and hospital admissions.9,10...
Letter to the Editor
Massive Retroperitoneal Adrenal Haemorrhage as the First Manifestation of a Lung Cancer
A 74-year-old man was admitted with sudden onset of right upper quadrant abdominal pain radiating towards right shoulder and right thigh. Pain was aggravated...
Others
4th FY Khoo Memorial Lecture 2008: Nasopharyngeal Cancer Workgroup – The Past, The Present and The Future
Thank you Madam Chairman. First, I would like to thank the Singapore Radiological Society and the College of Radiologists, Academy of Medicine Singapore for...
Original Article
Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative
Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms...
Original Article
Phase II Trial of Gemcitabine in Combination with Cisplatin in Inoperable or Advanced Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) has a high incidence rate in Asia. In Singapore, it is the third most common cancer amongst males, and constituted 8%...
Letter to the Editor
Pancreas-only Metastasis from Nasopharyngeal Carcinoma
A 51-year-old Chinese man presented with a 3 month’s history of left cervical lymphadenopathy, rhinorrhoea, tinnitus and nasal congestion. On nasopharyngoscopy, a fungating mass...
Letter to the Editor
Renal Artery Embolism in a Patient with Vague Abdominal Pain
Thromboembolism is a well-known complication of mitral stenosis especially when it is associated with cardiac dysrhythmias. However, renal artery embolism is a disease that...
Others
Clinical Characteristics of Renal Infarction in an Asian Population
Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months.
This article...
Original Article
Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience
Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year.
This article is available only...
Letter to the Editor
Successful Surgical Treatment of Renal Cell Carcinoma With Calvarial Metastases
Renal cell cancer (RCC) accounts for 3% of all cancers. Isolated haematuria or pain is the most common form of presentation.
This article is available...
Original Article
The Toxicity and Outcomes of Continuous 5-fluorouracil/Cisplatin-based Chemotherapy Followed by Chemoradiation in Patients with Resected High-risk Gastric Cancer: Results of a Single Institute
Gastric carcinoma is the second most common cause of cancer mortality worldwide. Surgery is the only curative therapy, although 5-year survival rates remain poor...
Others
Thoracic Complications of Radiofrequency Ablation of Recurrent Hepatoma
Radiofrequency ablation (RFA) intended to produce complete thermal necrosis of unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the...
Original Article
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian...
Original Article
MMP-2, TIMP-2 and CD44v6 Expression in Non-small-cell Lung Carcinomas
Studies have provided data that matrix metalloproteinases (MMPs) facilitate tumour invasion, the establishment of metastases. On the other hand, matrix metalloproteinase inhibitors have been...
Letter to the Editor
Mohs micrographic surgery in Singapore: A long-term follow-up review
Dear Editor,
Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS...
Original Article
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore
As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be...
Original Article
Characteristics of unplanned hospitalisations among cancer patients in Singapore
Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...
Original Article
Outcomes of Oral Tongue Cancer: Does Age Matter?
Oral cancer (including oral cavity and oropharynx) is the eighth most common cancer worldwide with oral cavity cancer among the 3 most common malignancies...
Letter to the Editor
Reply from Author: Putting the Wedge under Pressure
We thank the authors for their interest in our study and their insightful comments. We agree that filling pressures such as the central venous...
Letter to the Editor
Putting the Wedge under Pressure
We would like to thank Dr Huck Chin Chew et al for sharing their findings and we are appreciative of their work, “Oesophageal Doppler...
Original Article
Epidemiology of Snakebites from A General Hospital in Singapore: A 5-year Retrospective Review (2004-2008)
Snakes are present even in an industrialised country like Singapore. A bite from a venomous snake can inflict much morbidity and occasionally, it can...
Original Article
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent...
Letter to the Editor
Coexistence of Unicentric Castleman’s Disease and Locally Advanced Papillary Renal Cell Carcinoma: More Than a Coincidental Association?
Castleman’s disease (CD) is an enigmatic lymphoproliferative disorder due to its rarity, uncertain aetiopathogenesis and heterogeneous clinicopathologic forms. This case report presents an unusual...
Letter to the Editor
Management of Thrombotic Thrombocytopenic Purpura in Metastatic Prostate Cancer with only Endocrine Therapy
Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that presents acutely with multiple organ failure. Although defined classically as a syndrome with a pentad...
Original Article
Are New Resuscitation Guidelines Better? Experience of an Asian Metropolitan Hospital
Out-of-hospital cardiac arrest (OHCA) is a substantial public health burden that has poor prognosis. Patients who receive “good” and “high-quality” cardio-pulmonary resuscitation (CPR) have...
Original Article
Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer related mortality worldwide with an estimated 34,290 deaths recorded in the United States in 2008....
Original Article
An Eight Year Review of Exercise-related Cardiac Arrests
Exercise-related cardiac arrest is uncommon, however it is devastating when it occurs in otherwise healthy adults. In young adults, vigorous physical exercise trigger cardiac...
Original Article
Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore
Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A...
Original Article
A 5-year Profile of Trauma Admissions to the Surgical Intensive Care Unit of a Tertiary Hospital in Singapore
Our tertiary hospital has a 9-bed Surgical Intensive Care Unit (SICU) that caters to all surgical disciplines except Cardio-Thoracic and Vascular Surgery (which has...
Original Article
An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution
Thyroid lesions constitute a considerable bulk of surgical practice, majority of which are thyroid nodules. A large population study revealed that clinically apparent thyroid...
Original Article
An Epidemiological Study of 1348 Cases of Pandemic H1N1 Influenza Admitted to Singapore Hospitals from July to September 2009
On 17 April 2009, the US Centers for Disease Control (CDC) determined that febrile respiratory illness occurring in 2 children residing in adjacent counties...
Original Article
Outbreak of Pandemic Influenza A (H1N1-2009) in Singapore, May to September 2009
The first cases of infection with a novel influenza A (H1N1) strain were reported in 6 cases in California and 2 cases in Texas...
Original Article
Complementary and Alternative Medicine among Singapore Cancer Patients
Worldwide, the use of Complementary and Alternative Medicine (CAM) by cancer patients is highly prevalent. For cancer specialists, knowledge on CAM use in their...
Original Article
rTSβ as a Novel 5-fluorouracil Resistance Marker of Colorectal Cancer: A Preliminary Study
Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been...
Letter to the Editor
Dilemmas in Management of Brain Tumours in Pregnancy
Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case...
Review Article
Peritoneal-based Malignancies and Their Treatment
Peritonectomy or cytoreductive surgery has been described as the treatment of choice for selected patients with evidence of peritoneal carcinomatosis (PC) from the gastrointestinal...
Original Article
Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China
Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and...
Original Article
Demographic Determinants of Survival in Osteosarcoma
The treatment of osteosarcoma has seen tremendous improvements over the last 3 decades of the twentieth century. Over the last decade it appears that...
Original Article
The Hidden Impact of Childhood Cancer on the Family: A Multi-Institutional Study from Singapore
Chronic childhood illnesses have varying degrees of impact on the children and their families. Some chronic conditions that have little or no impact on...
Original Article
Causes and Features of Erythroderma
Erythroderma is a dermatological reaction characterised by extensive erythema and scaling of the skin secondary to a variety of causes. An improved understanding of...
Letter to the Editor
Routine intraoperative frozen section adds little value to the management of thyroid nodules with Bethesda III cytology
Dear Editor,
We would like to highlight the need to reduce intraoperative frozen section (FS) during diagnostic hemithyroidectomy performed on thyroid nodules with Bethesda III...
Letter to the Editor
Telemedicine for palliative care: Current and future challenges
Dear Editor,
We read with interest the article published in the June 2021 issue of the Annals titled “Use of telemedicine in healthcare during COVID-19...
Letter to the Editor
Managing buccal space tumours
Dear Editor,
The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are...
Letter to the Editor
Acute Marjolin’s Ulcer: A Forgotten Entity
Marjolin’s ulcers are malignancies that arise from areas of chronic irritation or injury that undergo malignant transformation after a period of many years. Such...
Original Article
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer...
Images in Medicine
A 22-year-old Woman Had a Lung Mass
A 22-year-old woman had an abnormal chest X-ray (Fig. 1) in her regular health examination. She was asymptomatic and a non-smoker. Chest computed tomography...
Letter to the Editor
Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma
Dear Editor,
Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised...
Original Article
Factors reducing inappropriate attendances to emergency departments before and during the COVID-19 pandemic: A multicentre study
Since the first case of coronavirus disease 2019 (COVID-19) was reported in China in late December 2019, the pandemic has spread throughout the world,...
Letter to the Editor
Low-Grade Fibromyxoid Sarcoma of the Thyroid: A Case Report
Dear Editor,
Low-grade fibromyxoid sarcoma (LGFMS) is a rare form of neoplasm that usually occurs in the deep soft tissue of the lower limbs with...
Review Article
Cognitive Aspect of Diagnostic Errors
It was an unusually busy ward round. The newly promoted registrar was keen to review the patients handed over to him. But there were...
Letter to the Editor
Five Patients with Medullary Thyroid Carcinoma Presenting as Asymptomatic Elevation of Carcinoembryonic Antigen Level
Early detection of malignancies is not easy. Few methods of health screening have been proven to be of value. The use of carcinoembryonic antigen...
Editorial
Too Much Medicine: Time to Stop Indiscriminate Cancer Screening
Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in...
Letter to the Editor
Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...
Editorial
Emergency Medicine Residency Programme in Singapore—Where Are We at Since Inception?
It has been 4.5 years since the Accreditation Council for Graduate Medical Education (ACGME-I) accredited competency-based emergency medicine residency programmes were started in July...
Images in Medicine
Bone in the breast: Clinical, radiological and pathological correlation
An 84-year-old woman presented with a left breast mass that had been rapidly growing over a few months. On clinical examination, there was a...
Letter to the Editor
Treatment of Ewing sarcoma in children: Results from a single centre
Dear Editor,
Ewing sarcoma is a malignant mesenchymal tumour that presents as a bone or soft-tissue sarcoma. Translocations involving the EWS gene on chromosome 22q12...
Review Article
Does pulmonary metastasectomy of colorectal metastases translate to better survival? A systematic review
Colorectal cancer (CRC) is the one of most common cancers worldwide. Metastatic disease occurs in approximately half of all CRC patients, in either synchronous...
Original Article
Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy
Oesophageal cancer is the 7th most common cancer in the world, with 572,034 new cases diagnosed in 2018, and is the 6th most common...
Original Article
A review of child sexual abuse cases presenting to a paediatric emergency department
Child sexual abuse (CSA) is a global public health issue with adverse short- and long-term repercussions. Formal definitions of CSA and the age for...
Letter to the Editor
Antibiotic stewardship algorithm to rationalise antibiotic use among hospitalised COVID-19 patients
As presentation of COVID-19 may mimic that of bacterial pneumonia, antibiotics are often prescribed. Concerns regarding overuse of antibiotics are now being raised particularly...
Letter to the Editor
Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore
The coronavirus disease 2019 (COVID-19) outbreak has impacted healthcare systems worldwide. Globally, visits to the emergency department have fallen as much as 25% during...
Original Article
Health-seeking behaviour of foreign workers in Singapore: Insights from emergency department visits
Singapore employs a large foreign worker (FW) population, defined as non-Singapore citizens and non-permanent residents working locally. Holders of “work permit” (WP), the work...
Original Article
Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there...
Editorial
Community-level interventions for out-of-hospital cardiac arrests in Singapore: Yay or nay?
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality and a significant public health problem globally. In Singapore, OHCA affected 11,061 adults between...
Letter to the Editor
Circulatory collapse from rupture of splenic artery aneurysm: A case study
Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted...
Original Article
Emergency airway management in a Singapore centre: A registry study
Emergency airways often present with little warning, and the need for airway management is necessary for a successful resuscitation. This is in contrast to...
Images in Medicine
An unusual submandibular tumour
A woman in her 60s presented with a non-tender, non-enlarging swelling in the left submandibular triangle of the neck for 3 months. She had...
Letter to the Editor
Decrease in emergency department attendances during COVID-19 especially in school-going children
Health-seeking behaviour varies during a pandemic. Early reports have suggested reduced attendances at emergency departments (EDs), especially in paediatric patients and in patients with...
Letter to the Editor
Penile preserving surgery in penile cancer management
Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates...
Original Article
Virtual reality mobile application to improve videoscopic airway training: A randomised trial
Emergency airway management is a keystone of emergency medicine practice and critical skill in residency training. An accredited emergency attending is expected to handle...
Original Article
Paediatric emergency department attendances during COVID-19 and SARS in Singapore
Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) on 11 March 2020, with over 110 million cumulative cases...
Original Article
Epidemiology and risk stratification of minor head injuries in school-going children
Head injuries are common childhood injuries that present to paediatric emergency departments. Falls are the most common cause in young children, while contact sports...