Dear Editor, The standard of care for endometrial cancer is a total hysterectomy with bilateral salpingo-oophorectomy, and pelvic lymph node dissection (THBSO-PLND). Obesity is a known risk factor for endometrial cancer, and obese patients are challenging to operate on due to their anatomy and comorbidities. A recent database search showed...

Dear Editor, Chronic kidney disease (CKD) is one of the key complications occurring in 25–40% of patients with type 2 diabetes mellitus (T2DM).1 Our earlier study also showed that CKD was present in 53% of patients with T2DM recruited from a secondary care diabetes centre and primary care polyclinic...

Dear Editor, Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However, BCS is associated with a higher risk for local recurrence, and published literature has reported re-excision rates as high as 20–70% due to positive resection...

Dear Editor, Transseptal access to the left heart is increasingly performed for electrophysiological procedures and for structural heart disease interventions such as balloon mitral valvuloplasty (BMV), left atrial appendage closure (LAAC) and transcatheter mitral valve repair (TMVr). Most of the iatrogenic atrial septal defects (iASDs) close spontaneously, and for those...

Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease. This article is available only as a PDF....

Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run over by a wagon resulting in bilateral suprapubic dislocation of his testes. This article is available only as a PDF. Please click on “Download PDF” on...

Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with the advent of modern non-invasive imaging techniques, percutaneous techniques performed under imaging guidance have, over the recent years, become increasingly acceptable as a suitable alternative...

Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to provide immediate repositioning of dental-osseous elements. In addition, splitting the palate may often be necessary to correct a functionally poor relationship of the maxilla to...

The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management of functional bowel disorders. We have previously published findings in the anaesthetised in vivo pig, that cisapride and mebeverine when infused IL into the sigmoid...

Dear Editor, More than 2 years since the start of the COVID-19 pandemic, cases continue to climb despite global efforts at viral control. This is largely driven by the emergence of viral variants. In the later part of 2021, the Delta variant was the predominant variant circulating globally, and was...

Dear Editor, The coronavirus disease 2019 (COVID-19) pandemic has impacted global healthcare including paediatric solid organ transplantation (SOT). We report our experience of resuming paediatric living-donor SOT during COVID-19, which took into account safety considerations for living donors, paediatric recipients and the transplant healthcare team. The US Centers for Disease...

The National University of Singapore was started in 1905. Since then, it has trained many generations of medical practitioners. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The theme of this issue of the Annals, Academy of Medicine at the beginning of the year is suitably on osteoporosis. Osteoporosis, with its multi-faceted, multidisciplinary approach, has been identified as one of the four clinical fields selected also for emphasis by the Bone and Joint Decade initiative. This article...

The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to control the haemodynamic fluctuations during phaeochromocytoma resection. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Given the rapid ageing of Singapore, all practising clinicians can expect to see an exponential rise in the medical and surgical problems of the elderly. One such condition is dementia. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The outcome of very-low-birth-weight (VLBW) premature babies with birth weights of <1500 g has remained an area of great concern for both parents and medical personnel. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

It is a great honour to be invited to deliver the Runme Shaw Memorial Lecture. I am grateful to the Runme Shaw Foundation for their support of this lecture. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Diaphragmatic rupture is a recognised consequence of high-velocity blunt trauma to the abdomen and chest and also has been reported in 0% to 5% of thoracoabdominal trauma patients. The diagnosis is often difficult and delay in diagnosis is implicated in increased morbidity and mortality. This article is available only as...

Diabetes mellitus (DM) is a common and growing healthcare problem in Singapore with a prevalence of 9% in 1998. Since the 1990s, the Ministry of Health, Singapore has identified DM as a priority condition for disease control. This article is available only as a PDF. Please click on “Download PDF”...

The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely attributed to advances in supportive therapy, diagnostic radiology and a better understanding of the pathophysiology of necrotising pancreatitis. This article is available only as a PDF....

The movement of people from one place to another has shaped today’s political, social and economic world and continues to be a major influence on society. In 2000, almost 175 million people, or 2.9% of the world’s population, were living outside their country of birth for 1 year or...

With the exponential increase in the elderly population in Singapore, the training of young physicians of tomorrow in the care of elderly patients will need to change accordingly. A potential way to fulfill this need is to increase the number of specialists proportionately to manage elderly patients effectively. This article...

Singapore has had only one medical school since 1905. This medical school, the Medical Faculty in the National University of Singapore (NUS), currently takes in about 230 students each year and its primary task is to train physicians for the entire nation. The NUS Medical Faculty is also involved...

While medical education in Singapore has a hundred-year history, the teaching of psychiatry became salient only in the last quarter of the century. In the early years, medical education mainly focused on medicine, surgery, paediatrics, obstetrics and public health. Fortuitously, interest in psychiatry grew as a consequence of social...

The Straits and Federated Malay States Government Medical School was established a century ago in 1905. The name of the school was changed to the King Edward VII Medical School, Singapore in 1912.1 In 1921, the title was changed to the King Edward VII College of Medicine.2 In 1949,...

In 2005, the Medical Faculty of the National University of Singapore (NUS) will commemorate the 100th year of its founding. The Straits and Federal Malay States Government Medical School, as it was called, had a humble beginning, with an enrolment of only 23 students in 1905. This article is available...

The Straits and Federated Malay States Government Medical School was founded in 1905. Dr Chen Su Lan, 1 of the 7 graduates in the first class to qualify in March 1910, reminisced in 1965 on his training experiences: “Among the ‘killer’ diseases were malaria (there were 20 deaths a...

Hip fractures constitute a major health concern for older persons and are associated with significant morbidity and mortality, with 1-year mortality rates ranging from 14% to 36% in spite of advancements in anaesthesia, surgical techniques and nursing care.1,2 In addition, epidemiological studies have shown that the incidence of hip...

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 as a PDF. Please click on “Download PDF” on top to view the full article.

In the US, Canada and Australia, the postgraduate training of family physicians (FPs) involves the attachment of family medicine (FM) trainees to specialist departments, similar to the model currently employed in Singapore. Unlike Singapore, however, FM training outside these hospital attachments is largely administered by senior FPs with minimal...

According to the World Health Organization/Global Initiative on Asthma (WHO/GINA) report on the global burden of asthma, Singapore is an intermediate-risk country for asthma prevalence, which is about 5% of the population. But has one of the highest rates of asthma deaths in the world. This article is available only...

Teaching, training, appraising and assessing doctors and students are important for the care of patients now and in the future.1 In most hospitals, trainee surgeons play a substantial role in providing healthcare and surgical services, under the supervision of a consultant. The Departments of Hand Surgery and Orthopaedic Surgery...

Cervical spondylosis is an extremely common condition managed by both physicians and surgeons in daily clinical practice. Cervical spondylotic myelopathy (CSM), resulting from longstanding degenerative impingement of the spinal cord and nerve roots by osteo-cartilagineous elements, is managed by conservative or surgical methods.1 While surgery is often performed in...

The delivery of good medical care and the safety of patients are of utmost importance in all healthcare systems. Indeed, healthcare providers need to rely on one anothers’skills to minimise risk and decrease the number of medical errors.1 This is of particular concern in the practice of obstetrics and...

The Inaugural Meeting of the Chapter of Psychiatrists and Chapter of Pathologists, Academy of Medicine, was held on 5 December 1986 at King’s Hotel.1,2 At that time the Academy already had 7 Chapters in her fold. The Chairman, Dr Lawrence Chan (then Master of the Academy of Medicine) remarked...

High-grade glioma (malignant glioma) is the most common primary intra-axial tumour of the central nervous system (CNS). Despite recent therapeutic advances in glioma treatment, the outcome for high-grade glioma has been disappointing. The first reported case of glioma resection was performed by Rickman Godlee in 1884.1 More than a...

A 36-year-old woman presented with a 4-month history of right neck lump. She had mild shortness of breath, but no dysphagia or voice changes. Clinical examination found a firm right thyroid mass that moved with swallowing, consistent with a right thyroid lesion. Ultrasound evaluation of the lump revealed a...

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 enables precise microscopic removal of tumour foci while allowing maximal tissue preservation, thereby maintaining cosmesis and anatomical function.1 The MMS service in Singapore started in...

President of the College of Surgeons, distinguished guests, friends, ladies and gentlemen. It is a great honour and a unique privilege for me to be invited to deliver a named lecture for a third time. Twenty years ago, I gave the first overseas Joint Lecture of the Academy and...

The training of surgeons composed of two aspects: (1) Clinical skill and competence; (2) The ‘soft’ skill and ‘art’ of surgery. With the gradual introduction of residency programme into the surgical discipline, hopefully our clinical training will be more systematic, closely supervised, monitored, assessed and reassessed, and structured. This article...

The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...

Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fistula formation may occur as the inflammation becomes chronic. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Since the first positive 2009 pandemic influenza A (H1N1) case was reported in Singapore on 26 May 2009, the country saw an exponential rise in numbers of infected cases despite initial containment followed by mitigation efforts. Local incidence for acute upper respiratory infections (which was a reasonable surrogate for...

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....

Submandibular masses are common presenting complaints in the outpatient setting. The differential diagnosis of a submandibular mass lesion can be salivary gland pathology, lymph nodal disease or soft tissue conditions. The more common submandibular gland pathologies include sialadenitis, sialolithiasis, pleomorphic adenoma, lymphoma and carcinomas. This article is available only as...

Despite the continuing emergence of sophisticated technology to aid diagnosis, many experienced clinicians continue to believe that bedside clinical skills relating to communication and physical examination remain fundamental to the practice and delivery of high quality patient care. Patients also regard doctors with a good “bedside manner”, as better...

Emergency gastrectomy has been associated with high morbidity and mortality rates. These complications arise as a direct consequence following the procedure, such as duodenal stump leak and intra-abdominal collections, or more frequently, because of the resultant systemic complications. This article is available only as a PDF. Please click on “Download...

Dear Editor, The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are rare and hence present a management challenge. In a recent systematic review of 217 patients, 4 main surgical approaches were identified (intraoral, extended parotidectomy/rhytidectomy, transcutaneous...

Hysteroscopy is an important surgical component of any training programme in gynaecology. Traditionally, surgical training in hysteroscopy occurred in the operating room where trainees first observe their senior performing the procedure, and then take on increasing roles in surgical cases under direct supervision. Often, hysteroscopic skills are acquired via a...

Muslim individuals worldwide participate in obligatory abstinence from oral consumption of medications, food and liquid during the fasting month of Ramadan. Fasting during Ramadan is one of the 5 pillars of Islam. However, Islam exempts individuals whose health may be significantly affected from fasting. Despite this, up to 80%...

In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their individual strengths to become an integrated academic healthcare cluster. This new academic healthcare cluster has a mission to provide outstanding clinical service, discover and promote...

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of AF,1 which increases with age, is 8% in people aged over 80. About three-quarters of the cases are non-valvular AF. The risk for stroke in...

A 55-year-old Chinese woman presented to the ear, nose and throat clinic with a 6-month history of left-sided blood-stained mucus. It was dark brown with no epistaxis. There was no mucopus, nasal obstruction, facial pain or fever. She denies any history of hypertension, trauma, head and neck cancer, anticoagulation...

A fit and well 78-year-old woman with no significant past medical history presented to the Emergency Department with large painless perianal ulcers. It started as an erythematous patch that developed into pruritic perianal blisters, and rapidly evolved into a necrotic ulcer over 2 days. She denied any prior injury...

Dear Editor, Osteoarthritis of the big toe (hallux rigidus) is a common arthritic condition of the first metatarsophalangeal joint (MTPJ), beginning with stiffness, pain and inflammation. This subsequently progresses to restriction of movements especially dorsiflexion.1 Articular surface degeneration and formation of periarticular osteophytes may be seen on radiographs.2 Common...

The COVID-19 pandemic has disrupted healthcare systems and health professions education (HPE). There are few frameworks to help educators manage HPE before, during and after pandemics and epidemics. We developed a crisis management framework which draws from diverse theories to emphasise preparedness, leadership, stakeholder perceptions and organisational learning to provide...

Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range, but this is impaired during general and/or neuraxial anaesthesia. Inadvertent peri-operative hypothermia is defined as a core temperature of <36C, the prevalence of which can...

Radiofrequency ablation (RFA) has been shown to be safe and efficacious in the treatment of benign thyroid nodules. Ion agitation during RFA generates high temperatures between 60 and 100 degree Celsius to cause tissue damage and size reduction.   This article is available only as a PDF. Please click on "Download...

With improvements in device technology as well as increasing experience, transcatheter aortic valve implantation (TAVI) has replaced open surgical aortic valve implantation as the treatment of choice in severe symptomatic aortic stenosis (AS) patients who have prohibitive and high surgical risks. TAVI has also gained increasing uptake in patients...