BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in Lille, France. In Singapore, all newborn babies are given the vaccination at birth, and until recently, a second vaccination was given to children at the...

Livedoid vasculitis is a clinicopathological entity that has variously been referred to as atrophie blanche, livedoid vasculopathy or segmental hyalinising vasculitis. It presents with purpuric lesions and recurrent, painful ulcerations of the lower limbs which result in depressed, atrophic white scars. This article is available only as a PDF. Please...

A postnatal finding of intracranial haemorrhage carries potential medico-legal implications for the obstetrician. However, one cannot exclusively attribute this to birth trauma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Pyriform sinus fistula is a developmental abnormality of the 3rd or 4th branchial pouch. It usually presents in childhood as acute inflammatory swelling of the neck and frequently involves the thyroid gland. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The Singapore shoreline has changed significantly over the last 30 years, but the stonefish (Synanceia sp.) continues to inhabit our native waters and human envenomation still occurs with relative frequency. In this paper, we document the clinical course, review our management experience and propose a treatment algorithm. This article is...

Acquired thoracic spinal canal stenosis is an uncommon condition compared to myelopathy and radiculopathy frequently seen in the cervical and lumbar spine, respectively. Because the rib cage restricts its movement, the thoracic spine is less prone to degenerative changes in the disc and facet joints, which result in loss...

Delusional parasitosis (DP), or delusional infestation, is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites. Originally described in 1894, it has been previously referred to as dermatophobia, parasitophobic neurodermatitis, parasitophobia or entomorphobia. This article is available only as a PDF. Please...

Chickenpox (varicella) in adults can be severe. It is frequently associated with pneumonia and immunosuppression as well as increased mortality rates. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterised by serous detachment of the macula, retinal pigment epithelial (RPE) detachment and areas of RPE atrophy that may represent sequelae of previous episodes. CSCR can arise secondary to chronic treatment with steroids. This article is available only as a PDF. Please...

Buprenorphine, more commonly known as Subutex (Reckitt Benckiser Pharmaceuticals), has been released in Singapore since 2002. Initially marketed as an opiate substitute to help addicts wean off their dependence, it has another formulation, Suboxone, which additionally contains naloxone as an active ingredient. This article is available only as a PDF....

Photodynamic therapy using verteporfin (Visudyne, Novartis Ophthalmics) has been proven safe and effective for the treatment of predominantly classic, age-related macular degeneration (AMD)-related subfoveal choroidal neovascularisation (CNV), pathologic myopia-related CNV, and subgroups of AMD-related occult CNV. Visual results following verteporfin treatment of subfoveal, non-AMD related CNV have been variable....

Liver abscess has been recognised since the time of Hippocrates. The first report on liver abscess was published by Bright in 1836.1 However, reports pertaining to liver abscess in the neonatal period have been published only since the 1930s. Neonatal liver abscess is a rare entity. To our knowledge,...

Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms: meningitis, mycotic aneurysms, infarcts and the tumoral form (aspergilloma). This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for ischaemic stroke within 3 hours from symptom onset. This article is available only as a PDF. Please click on “Download...

While the surgical procedure of placing dental implants may seem technically simple, it is not straightforward and requires careful preoperative planning. This article is available only as a PDF. Please click on "Download PDF" to view the full article.

Dissecting aneurysms of the vertebral artery often present with subarachnoid haemorrhage.1 A high mortality occurs with rupture.2 Currently, the treatment options for vertebral artery dissecting aneurysms presenting with subarachnoid haemorrhage (SAH) are still controversial and include trapping of the aneurysms with or without bypass as well as proximal occlusion,...

Pancreatic cancer is notoriously known to be diagnosed in the later stages and this carries with it a poor prognosis. In particular, tumours involving the head of pancreas are particularly difficult to diagnose early and computed tomography (CT) scanning often fails to detect an early tumuor at that site....

Renal transplantation is the best form of renal replacement therapy for patients with end-stage renal failure (ESRF), in comparison to dialysis, as it is associated with higher patient survivals, lower hospitalisation rates and a superior quality of life. However, the ever-increasing numbers of new patients with ESRF and the...

Patients suffering from visual field defects caused by optic nerve or post-chiasmatic injury commonly experience many limitations in their daily activities. The generally accepted paradigm that nothing can be done leaves little hope for such patients as restoration was once considered impossible. This article is available only as a PDF....

Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate of HPE is estimated to be between 1 in 11,000 to 1 in 20,000 live births, and 1 in 250 during early embryogenesis. This article is...

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

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor unit number estimation are useful for the evaluation of lower motor neuron (LMN) damage, there is at present no objective and quantitative technique to detect...

Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain reasonable metabolic requirement of the tissues at rest. Eventual loss of limb is the feared sequelae of CLI. This article is available only as a PDF....

Neovascularisation of the iris is associated with many ischaemia retinal disorders and elevated levels of the vascular endothelial growth factor is found in patients with neovascular glaucoma. Inhibition of the vascular endothelial growth factor has been shown to prevent retinal ischaemia-associated neovascularisation of the iris. This article is available only...

The occurrence of an adrenal mass in patients with an underlying malignancy may represent distant metastases, precluding curative surgical resection of the primary malignancy. On the other hand, it may simply represent a benign adrenal adenoma with no prognostic implications. In a cohort of lung cancer patients, an isolated...

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease with an incidence of approximately 0.5/1000 live births (5% to 7% of congenital heart lesions). In Singapore with a live birth of over 37, 000 per year,1 the expected number of new TOF cases will be approximately...

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 not without complications.1 One complication is that of aneurysmal dilatation, which can cause rupture and potentially fatal haemorrhage. This article is available only as a PDF....

In recent years, Singapore has seen a resurgence of dengue fever despite the seemingly successful implementation of a nationwide Aedes mosquito control programme,1 culminating in 9459 clinical and laboratory-confirmed dengue cases in 2004 and up to 13,653 cases in its 2005 dengue epidemic.2 This article is available only as a...

The auditory apparatus and vestibular part of the inner ear are often included in the radiation field treatment of patients with head and neck tumours.1-5 Radiation injury resulting in late-onset sensorineural hearing loss is a recognised complication, but the underlying pathological processes are poorly understood.4 Magnetic resonance imaging (MRI)...

Severe cases of influenza have traditionally generated much interest. The pandemic of 1957 provided instructive materials on the subject, with publications on the pulmonary complications and histopathologic features. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Complete atrioventricular block (AVB) develops in more than 5% of patients with myocardial infarction (MI). These patients have poorer outcomes compared to those without complete AVB. Thrombolysis has been demonstrated to improve the prognosis of such patients, especially those with inferior MI. This article is available only as a PDF....

End-stage renal disease (ESRD) is reaching epidemic proportions and is increasingly a public health issue due to the cost of providing care to these patients. There are many kidney disease databases and registries tracking and studying trends in the epidemiology and care of ESRD patients. This article is available only...

Chronic Achilles tendon rupture is a disabling condition resulting in ankle pain, weakened ankle plantarflexion and abnormal gait. Management of chronic ruptures is technically challenging with generally poorer outcomes and higher complication rates than that of acute repair. Current literature suggests this problem is still better tackled surgically although...

Simple cysts are commonly seen in neonatal ovaries. Majority of them are small and resolve spontaneously. Complications such as torsion and haemorrhage rarely occur, but when they do, they may cause symptoms due to mass effect such as bowel or urinary obstruction. Sonography plays an important role in diagnosis,...

Invasive fungal infections (IFI) are associated with a high mortality in liver transplant recipients. The incidence of fungal infections after liver transplantation ranges from 7% to 42%, with Candida sp. and Aspergillus sp. being the commonest pathogens. A prophylactic strategy against fungi is therefore attractive, and is practised in...

Clinical practice guidelines recommend different amounts of dietary protein intake for chronic kidney disease (CKD) patients. The recommended daily protein intake varies according to the level of kidney function (glomerular filtration rate (GFR) in mL/min per 1.73 m2 body surface area). It is unknown how effectively these recommendations perform...