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...

An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...

Dear Editor, Symptomatic haemorrhoids is the most common anorectal disorder, where up to 75% of people experience symptoms sometime in their lives.1 The current gold standard for the surgical management of haemorrhoids is the Milligan-Morgan haemorrhoidectomy,2 with unrivalled long-term results.3 However, the technique is associated with significant postoperative pain,4,5 leading to...

Non-parasitic cystic lesions of the spleen are unusual. They are classified essentially as primary (true, epithelial) and secondary (pseudo, non-epithelial) based on the presence or absence of lining epithelium. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The prevalence of human immunodeficiency virus (HIV) infection is rising at an exponential rate in Singapore. The surgical experience with this disease remains limited. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma of the cervix, because radiotherapy is the principle mode of treatment for this fourth most common malignancy in women in Singapore (after carcinoma of the...

Economic and social pressures are compelling surgeons to modify their practice. An increasing number of procedures are being done in an outpatient setting. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

First described by Johannes Muller in 1838 as a large, benign tumour of the breast. Phyllodes tumour is a rare pathological entity, accounting for no more that 1% to 3% of all breast lumps. This article is available only as a PDF. Please click on “Download PDF” on top to...

Thyroid nodule is a common problem in surgical practice. In 1994, more than 350 thyroid operations were performed in our department, of which 183 were for thyroid nodules. Conventional preoperative assessment of a patient with a thyroid nodule, including history and physical examination, radionuclide scan and ultrasonography, has been...

Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented but there is an even greater awareness that many non-specific symptoms like fatigue, depression and constipation are related to hypercalcaemia. This article is available only as...

Mr Koh Yong Guan, guest-of-honour; Dr Tan Ser Kiat, Master, Academy of Medicine; Dr K C Tan, Chairman, Chapter of Surgeons; Dr Robert Jalleh from Malaysia; Dr Idral Darwis from Indonesia; Dr P B Chacha, my esteemed partner; Dr John Isaac, Master of Ceremonies; fellow academicians, practitioners and friends,...

Doran, in 1903, reported the first case of adrenal cyst described by Greiselius in 1670. It was not until 1966 that Foster reported the 220th case. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Thoracoscopy was first introduced by Jacobaeus nearly a century ago. With the development of endoscopic equipment and the recent surge of interest in minimally invasive surgery, video-assisted thoracoscopy (VATS) has found many uses, both diagnostic and therapeutic, in the management of intrathoracic pathology. This article is available only as a...

The multiply injured patient presents a challenge to even the most experienced surgeon. These patients often present in shock and require a rapid diagnostic work-up to determine the presence of ongoing haemorrhage. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Alternative medicine has become widely publicised throughout the world. Alternative medicine practitioners (AMPS), which include Oriental medicine doctors, traditional Chinese medicine practitioners, naturopaths and Ayurvedic medicine practitioners, tout the ability to heal many diseases using treatments which are unconventional and of questionable scientific basis. This article is available only as...

A characteristic feature of renal cell carcinoma is the development of tumour thrombus extending into the inferior vena cava (IVC). This takes place in 4% to 10% of cases. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of gas to persistent lack of control of solid stools. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Although debridement of portions of liver that prolapsed through war wounds was recorded from distant times, attempts at resection of a solid liver tumour were first reported in the latter part of the 19th century. When one considers the enormous challenges faced by surgeons of the time, without the...

Colour image analysers have been extensively used in medical research since 1970 for histomorphometric studies. Image analysis gives more information and a better understanding of relative morphological changes in histological tissue sections. This is especially pertinent when different morphological areas are immunohistologically stained and present in contrasting colours or...

Despite intensive research and intervention, trauma continues to be the leading cause of death during the first three decades of life in the USA, and currently ranks as the fourth leading cause of mortality with over 160,000 deaths each year. Mortality following trauma occurs in three distinct periods. This article...

Liver transplantation (LTx) is the treatment of choice for many patients with end stage liver disease. However liver allograft availability prevents its widespread application. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years, it is the third (10.1%) most common cancer in males and the fifth (6.5%) most common cancer in females in Singapore. This article is available only...

Inguinal hernia is one of the commonest surgical pathologies in the world. Laparoscopic totally extraperitoneal repair has been gaining popularity in recent years. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Beginning in 1991, the Department of Forensic Medicine (DFM), which undertakes all Coroner’s casework locally, embarked on an on-going review of Coroner’s perioperative autopsies on a triennial basis. The aim is to document significant clinico-pathological and medico-legal trends arising from perioperative deaths in anticipation of the increasing importance of...

Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of all breast symptoms. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

In the last century, Sir William Ferguson said: “amputation—one of the meanest and yet one of the greatest operations in surgery: mean, where resorted to where better may be done, great as the only step to give comfort and prolong life.” Progress in peripheral vascular surgery over the past...

Although there has been a significant decline in elective surgery for peptic ulcer disease with the introduction of H-2 blocker, the incidence of peptic ulcer perforation has remained relatively unchanged over the years. The mortality rate from perforated peptic ulcer remains high as more perforations occur in the elderly...

Firstly may I thank the Academy of Medicine and the Chapter of Surgeons for giving me this great privilege and honour to deliver the final lecture of the century for our series of Chapter of Surgeons lectures to close the 20th century and begin a new dawn in the...

Although the incidence of oesophageal carcinoma is declining, it still remains a common cancer in Singapore. From 1988 to 1992, it was the ninth most common cancer in males (age-standardised rate, 8.9 per 100,000). This article is available only as a PDF. Please click on “Download PDF” on top to...

Thyroglossal duct remnant is one of the most common lesions of the anterior midline neck. It occurs in 7% of adults1 and carcinoma is found in less than 1%. The majorities are papillary and mixed papillary-follicular carcinomas, with follicular and squamous cell carcinomas occurring far less frequently. This article is...

On a global basis, the use of ultrasonography to assist clinicians in obtaining timely diagnoses in abdominal trauma is not particularly new. The first reported case of sonography to evaluate patients with splenic haematomas was in 1971, and by 1976, series of up to 70 victims of blunt trauma...

Acute appendicitis is a common surgical emergency. However, it is often difficult to make an accurate preoperative diagnosis, especially during the early stage of the disease. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that the clinical importance of these changes are being recognised.1-7 This coincides with the increasing availability of intensive care, which allows many more patients to survive...

Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While relatively uncommon in Western countries, it is the most prevalent malignant neoplasm in Southeast Asia, South Africa, and many other regions. This article is available only...

Mucinous cystadenoma of the vermiform appendix is an uncommon entity. It is a benign lesion but may disseminate and lead to the development of pseudomyxoma peritonei. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Over the past decade, sonography as a screening tool in the evaluation of abdominal trauma has been thoroughly investigated. This modality was first used by the Japanese and German surgeons. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Surgeons as well as patients have recently shown much interest in stapled haemorrhoidectomy. This is a new technique, which is claimed to result in less pain than traditional operations for haemorrhoids. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

The recorded history of breast cancer management spans four millennia. This story about breast cancer management is also one about change, about resistance to and acceptance of change. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Internal hernia is defined as the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. This unusual cause of intestinal obstruction occurs in 4% of all cases of acute intestinal obstruction. This article is available only as a PDF. Please click on...

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...

Today, laparoscopic surgery has achieved widespread acceptance among surgeons as well as the general public. Emergency laparoscopic procedures (ELPs) have been performed since the 1960s and with increasing experience, the benefits of laparoscopic surgery are being applied to non-elective situations. This article is available only as a PDF. Please click...

The carotid body was first described by von Haller in 1743. It is often a small ovoid or irregular mass composed of compact pinkish tan tissue and has an average size of 6 x 4 x 2 mm. This article is available only as a PDF. Please click on “Download...

A 40-year-old Chinese male presented with severe right loin pain. He had a history of chronic abdominal aortic dissection of unknown aetiology. He was not hypertensive and there was no evidence of ankylosing spondylitis, Ehlers-Danlos syndrome or any connective tissue disorder. This article is available only as a PDF. Please...

Intrahepatic biliary stone or hepatolithiasis is an uncommon entity worldwide, with a higher incidence in East Asia in comparison to the West. As yet, the aetiology remains to be clearly defined. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Acute ischaemia of the bowel is a devastating condition. Recently published figures on mortality range from 30% to 60%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy in certain cases provide curative treatment, more than 50% will develop metastases in the course of their disease. This article is available only as a PDF....

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

In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing optimal tumour clearance for patients with rectal cancer. Five cases were described where minute foci of adenocarcinoma was demonstrated in the mesorectum several centimetres distal...

It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal cancers which developed from flat or depressed neoplastic lesions remained undetectable by conventional colonoscopy. This article is available only as a PDF. Please click on “Download...

Inflammatory fibroid polyp is an uncommon nonneoplastic lesion found in the gastrointestinal tract. It is a benign, non-encapsulated submucosal lesion, composed mainly of loose connective tissues, vessels and with an eosinophilic inflammatory component. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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.

Next year, we celebrate a hundred years of medical education in Singapore. We have come a long way since 1821 – from a small, sleepy medical outpost catering to the British Armed Forces in the Far East, to an excellent state-of-the-art medical hub. This article is available only as a...

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 littoral cells line the vascular channels of the red pulp of the spleen and have characteristics of endothelial and histiocytic cells. In 1991, Falk et al described and characterised the tumoural component. This article is available only as a PDF. Please click on “Download PDF” on top to view...

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.

Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with colorectal cancers, but also because it implies a poor prognosis. We discuss 3 patients with rectal adenocarcinoma who subsequently developed cutaneous metastases. This article is available...

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....

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...

Traditionally the treatment of opioid dependence in Singapore has not been viewed as a public health problem, but rather as a social problem that necessitated custodial and other punitive approaches. The turning point came in 1996, when, after a pilot programme in the Prisons Department, naltrexone was introduced as...

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,...

In clinically-oriented subjects such as surgery, specific guidelines for conducting small group teachings are lacking. Different methods are being practiced and researched in different clinical subjects. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A 37-year-old man with no significant medical history underwent dental treatment. An injection dental needle used in the course of root canal treatment came loose, fell into the oral cavity and became directly irretrievable. This article is available only as a PDF. Please click on “Download PDF” on top to...

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...

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....

In a previous study,1 we reported that patients who had decreased proteinuria also had improvement in renal function. Three out of the 8 patients who had renal impairment prior to angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist (ACEI/ATRA) therapy regained normal renal function after therapy with ACEI/ATRA, while the remaining 5...

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...

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

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)...

Peritoneal dissemination of hepatocellular carcinoma (HCC) is a rare presentation, with an incidence of 2% to 6% detected during autopsy or laparoscopy. Although uncommon, the morbid and fatal complications associated with peritoneal metastases, especially in patients with liver cirrhosis and coagulation deficiencies, deserve renewed attention given recent advances in...

Colorectal cancer (CRC) is one of the commonest cancers worldwide with age standardised incidence rates of 22.8 to 64.2 and 19.0 to 46.7 per 100,000 in males and females, respectively. The disease accounts for one of the commonest causes of cancer death and the prognosis is closely related to...

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;...

Desmoid tumours are fibrous benign tumours that are often indolent until local symptoms evolve. We highlight a rare case of a ruptured intra-abdominal desmoid tumour presenting as acute abdomen. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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....

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...

A 45-year-old Chinese woman with no medical history or regular medications presented with painful nodules on her left shin that progressed to involve her right shin, thighs and lower back over a period of 3 months. There was associated lower limb joints stiffness. Systemic review revealed constitutional symptoms of...

A 61-year-old Chinese woman presented to the general surgery clinic for a long-standing lump over her proximal medial right thigh. The painless lump was first noticed 15 years ago and had been slowly enlarging since. She sought medical attention due to increasing discomfort while sitting and walking, as well...

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 lesions are predominantly squamous cell carcinomas (SCC) and have long been associated with burn scars. Here we describe an unusual case of Marjolin’s ulcer that...

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 a tendency towards local recurrence and distant metastasis. LGFMS affects mainly the young and middle-aged, with both gender having an equal chance of being affected. To...

A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC include failure of medical treatment or dysplastic changes following endoscopic evaluation. The timing of the surgery could hence be highly variable among patients. This article is...

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As the life expectancy of the population has improved significantly in the past few decades, a substantial portion of this rapidly ageing population will place a...

Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown. Ascites and gastrointestinal dysmotility in advanced cirrhosis, compounded by the need for dietary restrictions, often result in early satiety and anorexia. Inevitably, liver transplant wait-list...

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 cause of cancer-related mortality worldwide. Oesophageal squamous cell carcinoma (SCC) is the predominant histological subtype. However, the incidence of adenocarcinoma has risen among the Western...

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB) in the elderly is rare. We report a case of a 63-year-old man who presented with acute-on-chronic intestinal obstruction due to CAB, which caused pseudointestinal...

In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which have replaced open surgical high tie and stripping as the treatment of choice. CVI is common in the Western population and is reported to affect...

Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was treated with TAVI for severe aortic stenosis. The original concept of TAVI was simple: insert a stent-like device by creating an opening in the obstructed...

Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates in developing countries (2.8–6.8 per 100,000) compared to Western countries (as low as 0.3 per 100,000). However, in the UK, which is a developed country,...

Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted the management challenges faced in the emergency department (ED). This article is available only as a PDF. Please click on "Download PDF" on top to view...