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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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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%...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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....

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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,...

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...

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...