Letter to the Editor
Outcomes of patients admitted for drowning
Dear Editor,
According to the latest Utstein-style consensus, drowning is defined as the primary respiratory impairment resulting from submersion or immersion in a liquid medium.1 Patients may experience hypothermia, acute respiratory distress syndrome and shock.1 The pathophysiology is poorly understood, but could relate to physiological responses to temperature, water swallowing...
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, 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...
Commentary
The Lancet Commission on diagnostics: What it means for Singapore
Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and global disparity regarding this healthcare value chain has been one of the fundamental problems with prioritised urgency since the United Nation’s Millennium Development Goals were...
Others
Mesothelial Splenic Cyst—A Case Report
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.
Original Article
The StuI Polymorphism on Exon 8 of the Low Density Lipoprotein (LDL) Receptor Gene: Prevalence and Impact on Serum Lipid Levels in an Asian Cohort
The low density lipoprotein (LDL) particles in the plasma carry most of the cholesterol in circulation. High levels of plasma cholesterol and LDL-cholesterol are associated with increased risk of coronary artery disease (CAD).
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Original Article
Non-diagnostic Smears in Aspiration Cytology of Palpable Breast Lumps
A wide variety of neoplastic and non-neoplastic lesions have been described in the breast. Breast tissue is also subjected to many physiologic changes such as menstruation, pregnancy, lactation and ageing which lead to a spectrum of morphologic changes.
This article is available only as a PDF. Please click on “Download...
Others
Hypoglycaemia from Islet Cell Hyperplasia and Nesidioblastosis in a Patient with Type 2 Diabetes Mellitus—A Case Report
A 57-year-old woman was admitted to our hospital for perforated left tubo-ovarian abscess and found to have newly diagnosed diabetes with an admission blood glucose of 23 mM and glycated haemoglobin value of 12% (reference range 4.6% to 6.4%). She denied past symptoms of thirst, polyuria or polydipsia.
This article...
Others
Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding
Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in incidence of 3.68%. It comprises 22.8% of all local female cancers, with an annual mortality of 13.7 per 100,000 per year.
This article is available only...
Others
Sudden Death Due to Granulomatous Myocarditis: A Case of Sarcoidosis?
Granulomatous myocarditis and sarcoidosis are considered uncommon entities in our local community and sudden death due to either condition has not been described in local literature. Earlier local reports have alluded to the fact that sarcoidosis may be more common amongst Indian females and that more cases may be...
Review Article
CerbB2 Status in Breast Cancer: Pathologic Issues
The cerbB2 gene, also known as Her2/neu, encodes a transmembrane cell receptor with tyrosine kinase activity and epidermal growth factor receptor homology. All normal and the majority of breast cancer cells contain 2 copies of the cerbB2 gene and produce low levels of the corresponding protein.
This article is available...
Original Article
Epidemiology of Beta-haemolytic Group G Streptococcal Bacteraemia in Singapore (1996 to 1998)
Human isolates of group G streptococci (GGS) that form large colonies are similar to group A streptococci (GAS) in terms of virulence and cause a range of serious infections. These included infective endocarditis which had been emphasised in older reports1 but was found to be uncommon in later studies.
This...
Review Article
Nipah Encephalitis Outbreak in Malaysia
From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...
Images in Medicine
An intensely pruritic disseminated skin eruption
A 64-year-old man presented to the dermatology outpatient clinic with a 4-month history of pruritic papules. He had a significant medical history of thyrotoxicosis, which was diagnosed 1 year prior and well controlled on carbimazole. He had no history of dyslipidaemia or underlying malignancy. The cutaneous eruption had first...
Review Article
Lymphomas Involving Waldeyer’s Ring: Placement, Paradigms, Peculiarities, Pitfalls, Patterns and Postulates
As the histopathological diagnosis of any lymphoma still largely hinges upon the demonstration of lymphoid architectural abnormality, the pathologist must first be cognizant of the histology of normal and reactive lymphoid tissue in all contexts, particularly in extranodal tissue such as Waldeyer’s ring where unfamiliarity with lymphoid histological landmarks...
Review Article
Melanocytic Lesions of the Face: Diagnostic Pitfalls
Cutaneous melanocytic lesions are amongst the commonest tumours in all races but are more common in Caucasians with fair skin. Although most are benign melanocytic naevi that are readily diagnosed clinically, melanocytic lesions are commonly excised because of the concern that they may represent a melanoma or because of...
Original Article
The HercepTest and Routine C-erbB2 Immunohistochemistry in Breast Cancer: Any Difference?
The proto-oncogene c-erbB2 (also known as HER2/neu) is located on chromosome 17q21 and encodes a 185-kD transmembrane glycoprotein. It belongs to the human epidermal growth factor receptor (tyrosine kinase receptor) family that plays an important role in the regulation of fundamental processes such as cell growth, survival and differentiation.
This...
Others
Presumed Dapsone-induced Drug Hypersensitivity Syndrome Causing Reversible Hypersensitivity Myocarditis and Thyrotoxicosis
A 22-year-old Malay soldier doing his National Service was warded with a 6-day history of an itchy generalised rash associated with fever and lymphadenopathy. Prior to this episode, he was well and not known to have any major illnesses.
This article is available only as a PDF. Please click on...
Original Article
Study of Inherited Metabolic Disorders in Singapore – 13 Years Experience
Inborn errors of metabolism (IEMs) described in the early 1900s by Garrod were due to a block in a metabolic pathway, arising from an enzyme deficiency which led directly to the disruption of cellular metabolism. However 40 years later, it was discovered that many inherited diseases were not due...
Original Article
External Proficiency Testing Programmes in Laboratory Diagnoses of Inherited Metabolic Disorders
In order to monitor and ensure the quality of our laboratory diagnoses for inherited metabolic disorders (IMDs), our laboratory participated in the proficiency testing programmes organised by the Human Genetics Society of Australasia (HGSA) from Australia, and the College of American Pathologists (CAP) from USA. As the prevalence of...
Commentary
Buprenorphine-associated Deaths in Singapore
Buprenorphine is a thebaine derivative that was developed in the 1970s for pain relief. It was approved for substitution therapy in France in 1996, and in the USA in 2002.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Plasma and Urine Amino Acid Profiles in a Healthy Adult Population of Singapore
Analysis of blood plasma and urinary amino acids is required for the diagnosis and management of inherited metabolic disorders (IMDs) affecting one or more amino acids, such as phenylketonuria, tyrosinaemia, citrullinaemia, cystine-lysinuria, hyperglycinaemia, and maple syrup urine disease. It may also be useful for monitoring patients requiring long-term nutritional...
Letter to the Editor
Pericardial Thymoma: An Unusual Cause of Sudden Death
Thymomas are located in the normal location of the thymus, the anterior mediastinum. It is very rare for thymomas to arise primarily intrapericardialy.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Brief History of Pathology and the Chapter of Pathologists
A history of the Chapter of Pathologists would be incomplete without a history of the specialty of Pathology in Singapore. Pathology is in fact the first specialty practiced in Singapore. This was due to the seriousness of the public health situation and infections like water borne diseases in Singapore...
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 unusual presenting complaint and may arise from structural abnormalities persisting from birth such as a patent urachus or secondary to instrumentation.
This article is available only...
Letter to the Editor
Primary Epithelioid Angiosarcoma of the Lung Presenting as Left-sided Shoulder Pain
Primary angiosarcoma of the lung is a rare, often difficult to diagnose disorder with non-specific respiratory manifestations. Angiosarcoma involving the lung is usually a result of metastatic disease.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Macronodular Tuberculosis: Imaging Resemblance of Cholangiocarcinoma
The ability of multiphasic computed tomography (CT) and magnetic resonance (MR) studies in the diagnosis of liver tumours such as hepatocellular carcinoma and cholangiocarcinoma is well established. Nevertheless, potential mimics of malignant tumours abound. Hepatic tuberculosis presenting as hepatic mass is rare and preoperative diagnosis is usually difficult without...
Original Article
Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer related mortality worldwide with an estimated 34,290 deaths recorded in the United States in 2008. Of these, pancreatic ductal adenocarcinoma (PDAC) accounts for ~90% of all cases.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Drug-induced Kidney Disease – Pathology and Current Concepts
Departing from the usual account of drug-induced renal disease according to the specific type of drug, we divide this discussion into 3 main areas - glomerular injury, vascular injury and tubulointerstitial changes. In doing so, more emphasis will be placed on morphological findings although functional toxicity (with little or...
Others
Cardiac Rupture due to Fall: A Case Study
Studies have shown that cardiac ruptures due to blunt trauma are seen more often than expected. Isolated left ventricular injuries tend to be less common in blunt traumatic injuries, However, epicardial injuries and atrial ruptures are common findings in deaths due to falls. Literature reveals that cardiac injury should...
Editorial
Genome-wide Association Studies: Promises and Pitfalls
Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with the disease need to be identified. Hunting for the genes that cause or are associated with a particular disease is a challenging task.
This article is...
Letter to the Editor
Diagnosing Bacteraemia Early in Older Adults
Sepsis is a prevalent and important cause of morbidity and mortality in the general population. Approximately 750,000 patients in the United States alone develop severe sepsis each year. Of this, more than 60% are patients older than 65 years. Morbidity and mortality remain high in spite of advances in...
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 than 50 distinct serotypes have been identified since the early 1950s. The wide spectrum of symptoms includes upper respiratory tract illness, pneumonia, conjunctivitis, cystitis and...
Original Article
Safety and Effectiveness of Improving Carbapenem Use via Prospective Review and Feedback in a Multidisciplinary Antimicrobial Stewardship Programme
Multidrug-resistant (MDR) bacteria coupled with a rapidly diminishing antimicrobial pipeline has made antimicrobial resistance an international public health problem. Control strategies of MDR bacteria include infection control and antimicrobial stewardship programmes (ASP). The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have...
Original Article
Anaerobic Bacteraemia Revisited: Species and Susceptibilities
Over the last 2 decades, the importance of anaerobic bacteraemia has undergone various shifts in opinion. Early studies in the 1970s reported that anaerobes accounted for 2% to 20% of bacteraemia. However, by the mid 1980s, multiple centres reported declining rates of anaerobic bacteraemia, and several authors suggested that...
Letter to the Editor
Hypervirulent Klebsiella pneumoniae carriage in polyclinic attendees and national servicemen presenting with diarrhoea
Klebsiella pneumoniae liver abscess is an invasive syndrome that mainly affects people living in East Asia. It especially affects adults with diabetes and is caused by hypervirulent strains that possess the rmpA gene (regulator of mucoid phenotype A), iron sequestering genes, and usually belong to capsule types K1 and...
Letter to the Editor
Alternating hemiplegia of childhood presenting as recurrent apnoea in a term newborn infant
Recurrent apnoea in a term infant is usually pathologic, warranting a thorough aetiologic evaluation. An accurate diagnosis is essential in guiding subsequent management and understanding long-term prognosis.
This article is available only as a PDF. Please click on "Download PDF" to view the full article.
Original Article
PLA2R1 and HLA-DQA1 gene variations in idiopathic membranous nephropathy in South China
Membranous nephropathy is an organ-specific autoimmune disease and is the most common cause of adult-onset nephrotic syndrome. The diagnosis of membranous nephropathy mainly depends on pathological characteristics observed through various techniques such as diffuse thickening of the glomerular basement membrane and spike formation by light microscopy, granular deposition of...