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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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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,...

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...

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...

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,...

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...

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...

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...

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...

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...

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%...

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...

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...

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...

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...

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...

Pathological Pulmonary Hernia in a Patient With Metastatic Breast Cancer

Pulmonary hernia is a rare and uncommon clinical entity that has been defined as a protrusion of pleural membranes or lung parenchyma through the...

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...

Internationally, it is Time to Bridge the Gap between Primary and Secondary Healthcare Services for the Dying

Around two-thirds of people with incurable diseases in economically developed countries wish to die at home, but less than one third succeed in doing...

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...

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...

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...

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...

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...

The case for better hospitalisation selection in cancer patients

Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...

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...

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...

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...

Opioid Use amongst Cancer Patients at the End of Life

Opioid use in terminally ill cancer patients at the end of life has been a source of concern amongst many for fear of its...

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...

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...

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...

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 defi ned classically as a syndrome with a...

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...

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....

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Hospital Policy on Medical Futility — Does it Help in Conflict Resolution and Ensuring Good End-of-Life Care?

The concept of medical futility has been present since antiquity, and traditionally marked the shift in the primary goal of care to providing physical...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

How do English-speaking Cancer Patients Conceptualise Personhood?

Understanding the way personhood or “what makes you, you” is conceptualised is pivotal to the practice of medicine. Conceptions of personhood determine the moral...

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...

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...

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...

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...

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...

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...

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...

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...

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...