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A Case of Metastatic Nasopharyngeal Carcinoma in Benign Nasal Polyps

Our patient was a 39-year-old Chinese man with nasopharyngeal carcinoma (NPC) presenting initially with right upper cervical lymphadenopathy. He was treated primarily with a...

One Hundred and Seventy Cases of Childhood Onset Rheumatological Disease in Singapore

Children with rheumatological disease form a small but important proportion of the ill paediatric population. Most of the published data available are based on...

Systemic Sclerosis in DRw52-positive Silica-exposed Males: A Case Report

Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter....

Subclavian-oesophageal Fistula as a Complication of Foreign Body Ingestion: A Case Report

Ingested foreign bodies are a common condition in the practice of Otolaryngology. In particular, there is no doubt a greater tendency in the local...

Otitis Externa—The Clinical Pattern in a Tertiary Institution in Singapore

Although otitis externa is a common otological condition, the literature pertaining to it is sparse in contrast to the vast amounts of articles that...

Contrast-Enhanced Magnetic Resonance Imaging of the Internal Auditory Canals and Posterior Fossa

Contrast-enhanced magnetic resonance imaging (MRI) is now the gold-standard examination for the exclusion of acoustic schwannomas or other posterior fossa tumours. We retrospectively reviewed...

Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) Syndrome: A Brief Review of a Rare Condition

The acronym SAPHO refers to a syndrome characterised by synovitis, acne, pustulosis, hyperostosis and osteitis. In 1961, a link between acne conglobata and arthritis...

The Role of Occupational Therapy in Rheumatoid Arthritis Management

Rheumatoid arthritis is a systemic disease characterised by remissions and exacerbations that vary in severity and timing among people. Its chronic and degenerative course...

A Case of Sulindac-induced Enteropathy Resulting in Jejunal Perforation

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of various rheumatic conditions including rheumatoid arthritis (RA). The adverse effects of NSAIDs on...

Musculoskeletal Pain Clinic in Singapore—Sacroiliac Joint Somatic Dysfunction as Cause of Buttock Pain

Patient A, a 33-year-old male administrative coordinator presented with left buttock pain of 4 to 5 years duration which radiated down to the leg...

Intra-Synovial Corticosteroid Injections in Juvenile Chronic Arthritis—A Review

Locally injected intra-synovial corticosteroids are useful to target selected joint, tendon sheath or bursal inflammation in children with pauciarticular or polyarticular juvenile chronic arthritis...

Osteoporosis—The Need for a Paradigm Shift

Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased...

Managing Problem Gout

Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval...

Lipid Disorders and Rheumatic Diseases

The relationship between lipid disorders and arthritis is manifold. Hyperlipidaemia may manifest clinically in the musculoskeletal system. In 1968, Khachadurian studied 14 families of...

Rheumatoid Arthritis—A Review

Rheumatoid arthritis (RA) is a chronic inflammatory arthritis which is occasionally associated with extraarticular manifestations. Although the first good clinical description was by Landre-Beauvais...

Imaging of Thoracic Manifestations of Scleroderma

Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys,...

Overview of Imaging in Rheumatologic Diseases

Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations...

Advances in Antiphospholipid (Hughes’) Syndrome

Phospholipids (PLs) are components of cell membranes. Their function is not only to maintain the structure of the membranes but also to modify the...

The Appropriate Use of Antineutrophil Cytoplasmic Antibody (ANCA) Testing in Rheumatic Diseases

In 1982, Davies and co-workers in Melbourne described the presence of a serum factor that stained the cytoplasm of neutrophil leukocytes by indirect immunofluorescence...

Oral Tolerance: Mechanisms and Therapy of Autoimmune Diseases

Immunologic tolerance is a hallmark of the immune system whereby immune cells are tolerant of self antigen. Historically, this tolerance was thought to be...

The Genetics of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a chronic rheumatic disease characterised by protean clinical manifestations as well as the presence of multiple autoantibodies. Tissue deposition...

Systemic Lupus Erythematosus in Singapore

Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations...

Murine Lupus: Pathogenic Mechanisms and Genetic Origins

The complex and non organ-specific nature of systemic lupus erythematosus (SLE) has made it difficult for researchers to unravel the genetic defects and pathogenic...

Education in Rheumatology

The fact that there is an increasing and growing need in societies for care of sufferers of rheumatic conditions can be shown from national...

The Sensitivity and Specificity of Autoantibodies to the Sm Antigen in the Diagnosis of Systemic Lupus Erythematosus

The presence of multiple autoantibodies is the hallmark of systemic lupus erythematosus (SLE). Many of these autoantibodies target nuclear antigens e.g. histones, Sm, RNP,...

Clinical Predictors of Nephritis in Systemic Lupus Erythematosus

Lupus nephritis is a common manifestation of lupus associated with significant morbidity and mortality. The use of cytotoxic agents has resulted in improved renal...

Adult-onset Still’s Disease in an Oriental Population: Manifestations, Course and Outcome in 16 Patients

Although George Still first described systemic onset juvenile rheumatoid arthritis (JRA) comprising fever, arthritis, lymphadenopathy and splenomegaly in 1897, it was not until 1971...

Clinical Presentation and Disease Associations of Gout: A Hospital-based Study of 100 Patients in Singapore

Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate...

Ankylosing Spondylitis in Singapore: A Study of 150 Patients and a Local Update

Back pain is a common but often self-limiting problem. However, it is important to recognise causes of chronic backache such as ankylosing spondylitis which...

Development of Rheumatology in Singapore

Patients with rheumatic diseases frequently consult primary care physicians, internists and orthopaedic surgeons. In the past, few doctors took interest in these diseases. This article...

New Techniques for Surgical Decompression of Thyroid-related Orbitopathy

For a number of years, transantral orbital decompression formed the mainstay of surgical treatment of thyroid-related orbitopathy. The goal of this and several subsequently-described...

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral...

Otogenic Lateral Sinus Thrombosis—A Case Report

A 16-year-old boy, with a background history of beta-thalassaemia intermedia, splenectomy and hypogonadotrophic hypogonadism, was referred to our otolaryngological clinic for right otalgia following...

Tracheoesophageal Puncture Outcomes and Predictors of Success in Laryngectomised Patients

Laryngectomised patients have been shown to have significant physical and psychosocial problems. These relate not only to respiratory symptoms but also psychological symptoms such...

The Genetics of Spondyloarthropathies

The spondyloarthropathies (SpA) comprise a heterogenous group of conditions that include ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis/Reiter’s syndrome, arthritis associated with inflammatory bowel...

An Audit of Patients with Rheumatic Disease Requiring Medical Intensive Care

Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare...

New Disease Modifying Agents in Adult Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterised by symmetrical inflammatory arthritis. Most patients exhibit a chronic course. This article is available only as...

New Cyclooxygenase Inhibitors

Cyclooxygenase inhibitors are non-steroidal anti-inflammatory drugs (NSAIDs). They have been used in the treatment of rheumatic diseases for several decades. This article is available only...

10th Seah Cheng Siang Memorial Lecture: Going Places—A Rheumatological Odyssey

I am greatly honoured to deliver the 10th Seah Cheng Siang memorial lecture. I came into direct contact with Professor Seah in January 1965...

Immunotherapy in Autoimmune Diseases

In the early 1700s, Lady Mary Wortley Montagu, wife of the British ambassador to Turkey, introduced the practice of variolation against smallpox into Western...

A New Method of Evaluation of Upper Airway in Patients with Obstructive Sleep Apnoea— Computer-assisted Quantitative Videoendoscopic Analysis

Obstructive sleep apnoea (OSA) is characterised by a cessation of normal oronasal airflow for 10 seconds or longer, and repetitive closure of the upper...

Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more...

Unusual Endolaryngeal Extension of a Large Thyroglossal Duct Cyst

Thyroglossal duct cysts are the most common nonodontogenic cysts that occur in the neck. They can be complicated by infections and fistulae. This article is...

Thyroid Surgery—The Tan Tock Seng Hospital Otolaryngology Experience

The solitary thyroid nodule is a common clinical finding in the Otolaryngology practice. Although most lesions are ultimately shown to be benign, the management...

The Bone and Joint Decade 2000-2010: For Prevention and Treatment of Musculoskeletal Disease

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its...

Steroid-induced Osteoporosis

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed....

The Early Years of Otolaryngology in Singapore – 1946 to 1977

It was the late Dr BM Johns, a general surgeon, a New Zealander and Head of Surgical Unit “B” Singapore General Hospital (SGH), who...

Primary Meningococcal Arthritis and Endogenous Endophthalmitis: A Case Report

Primary meningococcal arthritis (PMA) and endogenous meningococcal endophthalmitis are both uncommon presentations of meningococcal infection that should be considered in the differential diagnosis of...

Validity and Reliability of the EQ-5D Self-report Questionnaire in Chinese-speaking Patients with Rheumatic Diseases in Singapore

Health-related quality of life (HRQoL) refers to patients’ perceptions of their own functioning and well-being. HRQoL is increasingly being used as a primary or...

Preoperative High Resolution CT and MR Imaging in Cochlear Implantation

Candidates for cochlear implantation undergo a thorough audiological and medical assessment. The audiological assessment is done to ensure that these candidates who have bilateral...

Intermittent Epoprostenol Infusions in Systemic Lupus Erythematosus Associated Pulmonary Hypertension—A Series of Three Cases

Pulmonary hypertension (PHT) is seen in 0.5% to 14% of systemic lupus erythematosus (SLE) patients and is associated with a grave prognosis. The overall...

Acute Isolated Sphenoid Sinusitis

Isolated infection of the sphenoid sinus is uncommon. It usually occurs in conjunction with infection of the other paranasal sinuses. Acute isolated sphenoid sinusitis...

Behcet’s Disease: Experience in a Tertiary Rheumatology Centre in Singapore and a Review of the Literature

The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only...

Accuracy of Fine Needle Aspiration Cytology and Frozen Section Histopathology for Lesions of the Major Salivary Glands

The histopathology of salivary gland tumours is extremely varied and complex. Amongst the epithelial neoplasms alone, at least 9 different adenomas and 17 different...

Septic Monoarthritis and Osteomyelitis in an Elderly Man Following Klebsiella pneumoniae Genitourinary Infection: Case Report

Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis....

Metastasis to the Sinonasal Tract from Sigmoid Colon Adenocarcinoma

A 52-year-old female was diagnosed with well-differentiated adenocarcinoma of the sigmoid colon in 1999. An anterior resection was performed followed by adjuvant chemotherapy for...

The Value of Joint Aspirations in the Diagnosis and Management of Arthritis in a Hospital-based Rheumatology Service

Joint aspiration with synovial fluid analysis can provide information which complements that which is available from the history and physical examination of the patient,...

A Rare Cause of Spontaneous Bleeding Per Oral in an Elderly

A 71-year-old female developed several episodes of intermittent bleeding from the mouth with an underlying history of foreign body sensation in the throat for...

Complications Following Tracheoesophageal Puncture: A Tertiary Hospital Experience

It has been nearly 3 decades since tracheoesophageal puncture (TEP) with valve prosthesis placement was first introduced as an alternative means of achieving voice...

A Missed Bilateral Choanal Atresia

What do you see in the image? a) Deviated posterior nasal septum b) Nasopharyngeal tumour c) Rhinolith with mucous plug d) Bilateral choanal atresia e) Nasal pyriform aperture stenosis This...

Unusual Presentation of a Solitary Thyroid Cyst

Recurrent laryngeal nerve (RLN) lies in close proximity with the thyroid gland. Thus, thyroid diseases, mainly the malignant ones, tend to cause irreversible recurrent...

Submandibular Mass Excision in an Asian Population: A 10-year Review

Submandibular masses are common presenting complaints in the outpatient setting. The differential diagnosis of a submandibular mass lesion can be salivary gland pathology, lymph...

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...

Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?

A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron emission tomography/computed...

Is the Apprehension Test Sufficient for the Diagnosis of Anterior Shoulder Instability in Young Patients without Magnetic Resonance Imaging (MRI)?

A good history and a detailed physical examination is often sufficient to make a diagnosis of a recurrent anterior dislocation of the shoulder, even...

Acute Onset Polyarthritis with Pitting Edema: Is it RS3PE?

A 48-year-old female presented with pain and swelling in the bilateral proximal interphalangeal (PIP), metacarpophalangeal (MCP) and wrist joints for the past 20 days....

Herpes zoster-associated aseptic arthritis in adult patients: A case report

Aseptic arthritis can often be associated with viruses— in the Singapore context—dengue or chikungunya viruses. The association of varicella-zoster virus (VZV) with arthritis however,...