Letter to the Editor
The practice patterns and perceptions of surgeons in Singapore regarding breast-conserving surgery
Dear Editor,
Breast-conserving surgery (BCS) is often the preferred treatment in operable breast cancer.1 While tumour biology and systemic therapy are major determinants of disease...
Letter to the Editor
A perfect match: The story of robotics in gynaecology
Dear Editor,
The first use of surgical robotics started in the domain of orthopaedic and urological surgery. However, it was the initial concept of using...
Letter to the Editor
Robotic surgery in morbidly obese women with endometrial cancer in Singapore
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...
Letter to the Editor
Association between self-care and chronic kidney disease in patients with type 2 diabetes mellitus
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...
Letter to the Editor
Surgical margins assessment reduces re-excision rates in breast-conserving surgery
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,...
Review Article
National surgical antibiotic prophylaxis guideline in Singapore
Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An...
Letter to the Editor
Iatrogenic atrial septal defect after catheter ablation—to close or not to close?
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...
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...
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...
Review Article
Bronchoscopy in the Intensive Care Unit (ICU)
Flexible fibreoptic bronchoscopy (FFB) has become an indispensable tool in the optimal management of intensive care unit (ICU) patients with both diagnostic and therapeutic...
Original Article
Use of Central Venous Lines in Paediatrics—A Local Experience
Peripheral access by venous cut down, once popular in the 1950s and 1960s, has almost become obsolete with the introduction of the Seldinger technique...
Others
Traumatic Dislocation of the Testes
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...
Original Article
Soft Tissue Cover in Compound and Complicated Tibial Fractures Using Microvascular Flaps
Compound tibial fractures are high-energy traumatic injuries, which are frequently associated with high incidence of complications like infection and failure of bony union leading...
Original Article
Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome
Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with...
Original Article
Excimer Laser Phototherapeutic Keratectomy for Recurrent Corneal Erosions
Recurrent cornea1 erosion (RCE) syndrome is a commonly encountered clinical condition which may be difficult to treat. Hansen first described it in 1872.
This article...
Original Article
The Role of Multiple Segment Osteotomies in Orthognathic Surgery
Multiple segment osteotomy (MSO) orthognathic surgery serves to combine total or segmental maxillary and mandibular correction of dentofacial deformities with concurrent diastematic procedures to...
Others
Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report
A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior...
Original Article
Direct Mucosal Targeting of Colonic Receptors by Prokinetic Drugs in an Experimental Model
The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management...
Others
Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia
Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes.
This article is available only as...
Original Article
The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury
Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...
Letter to the Editor
Impact of COVID-19 infections among kidney transplant recipients
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...
Letter to the Editor
Paediatric living-donor liver and kidney transplantation during COVID-19
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...
Original Article
Incidence and risk factors of delirium in post-anaesthesia care unit
Post-anaesthesia care unit (PACU) delirium is defined as a disorder in thought processes that affect cognition in terms of memory, comprehension and attention.1 It...
Others
A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore
BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in...
Original Article
A Twelve-year Review of Radical Cystectomies in Singapore General Hospital
Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of...
Others
Subdural Block—From a Spinal? A Case Report
There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...
Original Article
Problems Related to Epidural Analgesia for Postoperative Pain Control
Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...
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...
Others
Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports
The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...
Original Article
Transurethral Resection of Prostate (TURP) Through The Decades – A Comparison of Results Over the Last Thirty Years in a Single Institution in Asia
Over the last 70 years, transurethral resection of prostate (TURP) has been used in the surgical treatment of benign prostatic hyperplasia (BPH) and is...
Others
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...
Others
A Case of a Diaphragmatic Rupture Complicated With Lacerations of Stomach and Spleen Caused by a Violent Cough Presenting With Mediastinal Shift
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%...
Original Article
Audit of Diagnostic and Interventional Craniocervical Catheter Angiographic Procedures at the Singapore General Hospital
Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast...
Original Article
Cancellous Screw Fixation for Femoral Neck Fractures: One Hundred and Sixteen Patients
The incidence of hip fractures rises with increasing age, doubling for each decade beyond 50 years of age. With the increase in life expectancy...
Original Article
Spectrum of Dentofacial Deformities: A Retrospective Survey
Deformity refers to distortion of any part of the body. The term dentofacial is related to the dental arches and their effects on facial...
Original Article
Infected Pancreatic Necrosis – An Evaluation of the Timing and Technique of Necrosectomy in a Southeast Asian Population
The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely...
Others
Can Long-term Corticosteroids Lead to Blindness? A Case Series of Central Serous Chorioretinopathy Induced by Corticosteroids
Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE...
Others
Ethambutol-associated Optic Neuropathy
Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to...
Original Article
Carbon Monoxide Poisoning: A Five-year Review at Tan Tock Seng Hospital, Singapore
Carbon monoxide (CO) is an odourless, tasteless and toxic gas and is the most abundant pollutant in the lower atmosphere. It is produced largely...
Others
Swallowed Foreign Bodies in Children: Report of Four Unusual Cases
Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating...
Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain,...
Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a...
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
Advanced Burkitt’s Lymphoma Presenting With Jejunal Perforation
Burkitt’s lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin’s lymphomas. It is predominantly seen in children but may also...
Original Article
Surgical Training in Singapore: Will Patients Consent to Trainee Surgeons Performing Their Operations?
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...
Others
The Role of Electrophysiology in the Diagnosis and Management of Cervical Spondylotic Myelopathy
Cervical spondylosis is an extremely common condition managed by both physicians and surgeons in daily clinical practice. Cervical spondylotic myelopathy (CSM), resulting from longstanding...
Others
Arteriovenous Fistula Aneurysm – Plicate, Not Ligate
Arteriovenous fistulae (AVF) are created for haemodialysis in patients with end-stage renal failure. While AVF is a lifeline for these patients, its creation is...
Original Article
An End to “See One, Do One and Teach One” Residency Training Programme – Impact of the Training, Education, Surgical Accreditation and Assessment (TESA) Programme on Medical Care and Patients’ Safety†
The delivery of good medical care and the safety of patients are of utmost importance in all healthcare systems. Indeed, healthcare providers need to...
Original Article
From a “Generalist” Medical Graduate to a “Specialty” Resident: Can an Entry-level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainees
Undergraduate medical education is considered a continuum leading into postgraduate training and ultimately medical practice.1 To this effect, it has been suggested that measures...
Review Article
The Role of Surgery in High-grade Glioma – Is Surgical Resection Justified? A Review of the Current Knowledge
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,...
Original Article
Perforated Appendicitis in Children: Benefits of Early Laparoscopic Surgery
Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal...
Images in Medicine
Beware the anterior lying recurrent laryngeal nerve in a retro-oesophageal goitre
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....
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...
Others
5th College of Surgeons Lectureship: Surgery beyond Scalpels
The training of surgeons composed of two aspects: (1) Clinical skill and competence; (2) The ‘soft’ skill and ‘art’ of surgery. With the gradual...
Letter to the Editor
Peritoneo-Cutaneous Fistula Secondary to Skin Excoriation from a Large Chronic Incisional Hernia
Incisional hernias are common complications following abdominal surgery with an incidence of 2% to 20% after midline laparotomy. Umbilical fluid discharge is, however, an...
Original Article
Epidemiology and Management of Surgical Upper Limb Infections in Patients with End-stage Renal Failure
Hand infections are common in the general population, and their management is usually uncomplicated. Several papers have noted that patients with diabetes mellitus have...
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
Renojejunal Fistula: An Extremely Rare Form of Renoenteric Fistula
Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fistula formation may occur as the...
Original Article
Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?
The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and...
Original Article
The Singapore National Healthcare Group Diabetes Registry – Descriptive Epidemiology of Type 2 Diabetes Mellitus
Diabetes mellitus is one of the most challenging global health problems in the 21st century. It is associated with excess mortality and significant morbidity...
Original Article
Functional Outcomes of Cancer Patients in an Inpatient Rehabilitation Setting
Cancer is the leading cause of death and the second most common cause of hospitalisation in Singapore. Cancer rehabilitation aims to help the patient...
Original Article
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...
Original Article
Early Outcome Following Emergency Gastrectomy
Emergency gastrectomy has been associated with high morbidity and mortality rates. These complications arise as a direct consequence following the procedure, such as duodenal...
Original Article
Clinical Outcome and Cost Comparison Between Laparoscopic and Open Appendicectomy
Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open...
Original Article
Neonatal and Paediatric Extracorporeal Membrane Oxygenation (ECMO) in a Single Asian Tertiary Centre
Extracorporeal membrane oxygenation (ECMO) is a cardiopulmonary bypass technique (CPB) introduced by Bartlett in 1972, which provides life-saving support in patients with refractory yet...
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...
Original Article
Get “Real” with Hysteroscopy Using the Pig Bladder: A “Uterine” Model for Hysteroscopy Training
Hysteroscopy is an important surgical component of any training programme in gynaecology. Traditionally, surgical training in hysteroscopy occurred in the operating room where trainees...
Original Article
Risk Factors for Severe Adenovirus Infection in Children during an Outbreak in Singapore
Human adenoviruses (HAdVs) are well known pathogens that cause a variety of human illnesses. They are non-enveloped, linear double-stranded deoxyribonucleic acid (DNA) viruses. More...
Original Article
A Novel “Box Lesion” Minimally Invasive Totally Thoracoscopic Surgical Ablation for Atrial Fibrillation
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...
Images in Medicine
A maxillary sinus mass
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...
Images in Medicine
Rapidly progressive ulcer in an older woman
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...
Letter to the Editor
Joint preserving surgery for osteoarthritis of the big toe using a cartilage-like implant
Dear Editor,
Osteoarthritis of the big toe (hallux rigidus) is a common arthritic condition of the first metatarsophalangeal joint (MTPJ), beginning with stiffness, pain...
Letter to the Editor
A survey of Singapore anaesthesiologists for practice and prevention of peri-operative hypothermia in adult surgical patients
Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range,...
Letter to the Editor
Pilot study of single-session radiofrequency ablation of benign thyroid nodules in Singapore
Radiofrequency ablation (RFA) has been shown to be safe and efficacious in the treatment of benign thyroid nodules. Ion agitation during RFA generates high...
Original Article
Impact of Chronic Kidney Disease on Outcomes in Transcatheter Aortic Valve Implantation
With improvements in device technology as well as increasing experience, transcatheter aortic valve implantation (TAVI) has replaced open surgical aortic valve implantation as the...