Letter to the Editor
“Leveraging ChatGPT to aid patient education on coronary angiogram”: Correspondence
Dear Editor,
“Leveraging ChatGPT to aid patient education on coronary angiogram”1 is an interesting article. The study assessed ChatGPT’s ability to conversely provide information regarding the coronary angiography process, pointing out its advantages and disadvantages. Although ChatGPT provided information in an exhaustive and methodical manner, it also had flaws, including...
Letter to the Editor
Impact of risk stratification on cardiovascular outcomes in patients with stable chest pain
Dear Editor,
Chest pain is a common presenting complaint among patients visiting primary care1 and is a frequent reason for referral to the outpatient cardiology clinic. The European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines advocate estimating pre-test probability (PTP) of obstructive coronary artery...
Letter to the Editor
Tele-ECG collaboration between tertiary and primary care in Singapore: Outcomes and learning over a 6-year period
Dear Editor,
An electrocardiogram (ECG) is the mainstay of cardiac evaluation available in primary care, after which assessment in relation to clinical symptoms and signs is made by family physicians to assess the patients holistically. Subsequently, based on this clinical evaluation, patients may then be referred for tertiary review at...
Letter to the Editor
Optimising percutaneous valve-in-valve TAVI with bioprosthetic valve fracture
Dear Editor,
Percutaneous transcatheter aortic valve implantation (TAVI) has become an established therapy for inoperable patients, for high, intermediate and low surgical-risk patients over 65 years old with severe aortic valve stenosis (AS).1,2 Valve-in-valve (ViV) TAVI is an approved indication for patients with degenerated aortic surgical bioprostheses.
Several ViV TAVI registries...
Letter to the Editor
Comparing the effectiveness, safety and cost of teleconsultation versus face-to-face model of pharmacist-led anticoagulation clinic: A single institution experience
Dear Editor,
Teleconsultation-based (TELE) anticoagulation clinic (ACC) is an alternative modality, but its use in Singapore’s clinical setting has not been well studied. In Tan Tock Seng Hospital (TTSH), the TELE ACC service was established to enrol patients who (1) perform self-testing using a loaned point-of-care (POC) international normalised ratio...
Editorial
Direct oral anticoagulant: Looking beyond convenience
Since the 2010 Food and Drug Administration approval of Dabigatran as the first non-vitamin-K antagonist oral anticoagulants or direct oral anticoagulants (DOACs) as it is now more commonly referred to, there has been much development in the field with increasing availability of different DOACs and an expansion in indications...
Review Article
Strategies to prevent cardiovascular disease in Singapore: A call to action from Singapore Heart Foundation, Singapore Cardiac Society and Chapter of Cardiologists of the Academy of Medicine, Singapore
Despite the success of Singapore’s public health systems in providing medical care through the country, there is still much to be achieved in terms of optimising the cardiovascular (CV) health of its 6 million residents. According to the 2019 Global Burden of Disease report, while the incidence rate of...
Original Article
Clinical utility of PET/MRI in multiple myeloma
Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...
Review Article
Cardiovascular effects of COVID-19 in children
The global coronavirus disease 2019 (COVID-19) pandemic was caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). While the respiratory system is the primary infectious target of SARS-CoV-2, systemic symptoms are fairly common and organ systems throughout the body can be affected with multisystem organ failure in the...
Editorial
COVID-19: The virus, vaccine and paediatric heart
The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality around the world. The development of vaccines has cushioned the effect of the virus and thus, provided hope in the fight against the disease.1 Yet, there are still small battles with COVID-19, at the bench and...
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Original Article
Fetal congenital heart diseases: Diagnosis by anatomical scans, echocardiography and genetic tests
Congenital heart diseases (CHDs) are the most common major congenital anomaly at up to 28%1 and are responsible for 5.7% of all infant mortality.2 While earlier studies in developed countries reported an overall CHD birth prevalence of 3.7–5.54 per 1000 live births,3,4 more recent studies report a global and...
Commentary
Leveraging ChatGPT to aid patient education on coronary angiogram
Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare.1 Traditionally, inclusion of technology in the augmentation of healthcare communication comprised the use of chatbots, which is limited by a predetermined set of queries and matched answers.2 However, natural-language AI models prompt a...
Original Article
Effects of sex on clinical outcomes of hypertrophic cardiomyopathy in Singapore
Hypertrophic cardiomyopathy (HCM) is a common inherited cardiomyopathy.1 The phenotypic expression of HCM is highly diversified with varying extents of myocardial hypertrophy, which can affect different parts of the heart and result in varying extents of left ventricular outflow tract (LVOT) obstruction, diastolic dysfunction and arrhythmic potential. The large...
Editorial
Promise and pitfalls of ChatGPT for patient education on coronary angiogram
The past decade has seen extraordinary and rapid progress in the field of artificial intelligence (AI), which produces computer systems capable of performing tasks that typically require human intelligence. These advancements have yielded wide-ranging applications across various domains that are revolutionising industries and transforming the way humans live and...
Letter to the Editor
Preferences for oral anticoagulant medications for managing atrial fibrillation
Dear Editor,
Stroke prevention in patients with atrial fibrillation (AF) using anticoagulants involves weighing the benefits of reduced ischemic stroke1,2 against the elevated risks of serious bleeding events.3 Warfarin and direct oral anticoagulants (DOACs) are the available oral anticoagulants for this indication. We developed a discrete choice experiment (DCE) survey4...
Original Article
Comparison of four electrocardiographic criteria for the detection of cardiac abnormalities in Singapore athletes
Sudden cardiac death in athletes during exercise is rare, with an estimated incidence of 1–2 per 100,000 people per year in young athletes,1 and approximately 1 per 7,000 per year in adult athletes.2 The predominant aetiology of these cases is cardiovascular in nature, with conditions such as hypertrophic cardiomyopathy...
Editorial
Improving electrocardiogram interpretation in Asian athletes: A call to action
The field of sports cardiology has evolved substantially over the past 2 decades due to improved understanding of the athlete’s heart, causes of sudden cardiac death (SCD) in athletes, as well as differentiation between physiological cardiac remodelling and pathological cardiac conditions in athletic individuals. Application of this knowledge forms...
Letter to the Editor
Outcomes of selexipag for treatment of pulmonary arterial hypertension in an Asian population
Dear Editor,
Pulmonary arterial hypertension (PAH) is a progressive condition characterised by increased pulmonary arterial pressure and pulmonary vascular resistance, resulting in right ventricular dysfunction and eventually cardiac failure. In the early days, this was an often a fatal disease with significant morbidity. In recent years, there has been increasing...
Letter to the Editor
Suboptimal adherence to medical therapy in patients undergoing lower limb angioplasty in Singapore
Dear Editor,
Chronic limb-threatening ischaemia (CLTI) is the advanced stage of peripheral arterial disease (PAD) and patients with this condition face a very high risk of major adverse cardiovascular events and mortality. Several guidelines strongly recommend evidence-based medical therapy (EBMT) to reduce cardiovascular risk.1-3 Specifically, all CLTI patients should be...
Original Article
Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging
Allergic and non-allergic hypersensitivity reactions to iodinated contrast media (ICM) are increasingly recognised, particularly the latter where there is greater clarity on pathomechanisms.1 There is limited evidence for the use of corticosteroids as premedication to prevent the occurrence of contrast-related reactions. At our institution, a dose of 30mg oral...
Editorial
Preventing recurrent hypersensitivity reactions to iodinated contrast media
Iodinated contrast media (ICM) is one of the most commonly used drugs in the practice of modern medicine. ICM, as the name implies, is a contrast media that contains iodine. It is frequently used in computed tomography (CT) and angiographic procedures, to highlight important anatomical structures and for the...
Commentary
Approach to bradyarrhythmias: A proposed algorithm
Bradyarrhythmias are common and occur in both physiological and pathological states. Bradycardia is defined as a heart rate of fewer than 60 beats per minute, and bradyarrhythmias can be caused by sinus node dysfunction or atrioventricular (AV) conduction blocks.1,2 Atrial fibrillation (AF) with a slow ventricular response may also...
Review Article
Ablation therapies for paroxysmal atrial fibrillation: A systematic review and patient-level network meta-analysis
Atrial fibrillation (AF) is a pertinent health condition that is seeing a sustained rise in global incidence and prevalence.1 In particular, paroxysmal AF (PAF), despite its transient nature, is associated with a slow but steady progression to persistent AF2 and increased mortality compared to patients without AF.3 Furthermore, patients...
Editorial
Catheter ablation as first-line treatment for paroxysmal atrial fibrillation
Pharmacotherapy has been the mainstay of atrial fibrillation (AF) treatment. As AF progresses from paroxysmal to persistent, electrical and structural remodelling of the atria may become irreversible, rendering future rhythm-control therapies less effective. Results of earlier trials on rhythm control were disappointing and failed to establish the superiority of...
Letter to the Editor
Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations
Dear Editor,
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations. It can involve single or multiple organs, and presentations range from asymptomatic lesions detected incidentally on imaging to severe organ dysfunction. Hence, accurate and timely...
Commentary
Low-dose computerised tomography screening for lung cancer in Singapore: Practical challenges of identifying participants
INTRODUCTION
In March 2022, the European Commission on cancer screening suggested the inclusion of low-dose computerised tomography (LDCT) for lung cancer, targeted at current and former smokers.1 The aim of LDCT screening is to increase early detection, decrease diagnoses at metastatic stage of the disease and improve overall 5-year...
Original Article
Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation
The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and major adverse cardiac events (MACE) seen in this group of patients even after surgical aortic valve replacement (SAVR).1,2
In recent times, the role of transcatheter aortic...
Images in Medicine
TB or not TB? The axillary lump question
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...
Original Article
Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation
Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with increased risks of stroke, dementia, heart failure (HF) and death.1 Globally, 33.5 million people were reported to have AF in 2010,2 with numbers expected to increase exponentially by 2050.3-7 While in part due to ageing...
Editorial
Different strokes for different folks
Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven first documented ECG tracing of AF in 1906. Fast forward several hundred years since its first observation, AF remains a mystery from its pathogenesis and...
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...
Editorial
Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction
With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction (HFmrEF), much has yet to be fully understood with regard to patient demographic, clinical presentation, response to guideline-directed heart failure therapies, and outcome across the...
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 (BMV), left atrial appendage closure (LAAC) and transcatheter mitral valve repair (TMVr). Most of the iatrogenic atrial septal defects (iASDs) close spontaneously, and for those...
Commentary
Cardiac sarcoidosis: Difficulties in diagnosis and treatment
Sarcoidosis is a multisystem, granulomatous disorder of unknown aetiology. It affects the lungs in 90% of cases, but is also known to affect other organs including the skin, liver, spleen, kidneys and heart.1 Cardiac sarcoidosis (CS) is thought to clinically affect 5% of those with sarcoidosis, manifesting as conduction...
Letter to the Editor
Safe time interval for screening estimated glomerular filtration rate prior to gadolinium-enhanced MRI scan
Dear Editor,
Magnetic resonance imaging (MRI) contrast media are commonly used in medical imaging and are usually gadolinium-based contrast agents (GBCAs). They can be divided into 3 groups. Group I consists of compounds with linear molecular structures. Group II consists of compounds with macrocyclic molecular structures. Group III currently includes...
Editorial
Out-of-hospital cardiac arrest in Singapore: Can we do better?
Cardiac arrests are unpredictable events that frequently result in death or significant residual morbidity among survivors. These sudden events affect not only the individual, but are understandably also significant life events and stressors for the family and friends. As such, the impact of cardiac arrests is felt on a...
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...
Editorial
Sepsis and cardiovascular events: The story so far
Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that leads to admission to the intensive care unit (ICU). Although advances have been made in the management of sepsis, mortality from sepsis remains high.2 Among...
Letter to the Editor
Previous history of hyperthyroidism in emergency department patients with atrial fibrillation does not increase the risk of thromboembolism and death
Dear Editor,
Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision for anticoagulation is guided by risk scoring systems that include factors such as age, sex and comorbidities.1,2 AF can sometimes occur in patients with active...
Editorial
Pressures, indexes and peripheral arterial disease: Time to rethink our approach?
Most patients with peripheral arterial disease (PAD) are asymptomatic. Despite the absence of symptoms, these patients have a significantly increased risk of death and adverse vascular events.1 Early detection of individuals with asymptomatic PAD facilitates prompt introduction of secondary prevention (lifestyle modification, smoking cessation, anti-platelet medications and lipid management)....
Original Article
Reduction in Retake Rates and Radiation Dosage Through Computed Radiography
New computed radiography imaging systems are slowly gaining a foothold in radiological departments worldwide. By computed radiography we mean a digital imaging system which exposes a photostimulable phosphor image receptor plate to obtain a latent image using existing radiographic equipment.
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Original Article
Computed Tomographic and Magnetic Resonance Imaging Findings in Paranasal Sinus Involvement in Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma (NPC) is an aggressive infiltrative neoplasm. Spread into the paranasal sinuses is often seen but the frequency is documented in only a few series.
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Original Article
Drug Treatment of Hypercholesterolaemia
Serum cholesterol has been established as a major risk factor for coronary heart disease (CHD). There is a linear association between serum cholesterol level and CHD mortality and morbidity.
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Original Article
Goldberger’s Triad in Dilated Cardiomyopathy—Can it Predict the Severity of Left Ventricular Dysfunction?
In 1982, Goldberger described a novel electrocardiogram (ECG) triad that was highly specific for patients with dilated cardiomyopathy and congestive heart failure (attributable to various aetiologic factors), with a sensitivity of 70%, a specificity of 99%, and a positive predictive value of 91%. For unknown reasons, ventricular dilation causes...
Others
Thyroid Storm Presenting as Jaundice and Complete Heart Block
Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered mental status. With the “apathetic” variant of hyperthyroidism, the classical features may not be evident.
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Others
Book Review
This book is a collection of 30 case studies, which were published in the Singapore Medical Journal from 1994 to 1997. They include interesting cases from all the major anatomical regions and organ systems.
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Others
Simultaneous Transcatheter Valvuloplasty and Amplatzer Septal Occlusion for Pulmonary Valvar Stenosis and Secundum Atrial Septal Defect
Congenital pulmonary valvar stenosis (PVS) and secundum atrial septal defect (ASD) are relatively common forms of congenital heart disease (CHD). Since the first successful clinical application of transcatheter balloon dilation of PVS in 1982, the latter has become the treatment of choice for children with PVS who have significant...
Others
Electrocardiographic Abnormalities in Combined Hypercalcaemia and Hypokalaemia—Case Report
The electrocardiographic abnormalities in isolated hypercalcaemia and hypokalaemia have been well documented in the literature. However, electrocardiogram (ECG) findings in combined hypercalcaemia and hypokalaemia have rarely been described.
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Original Article
Bone Mineral Density—Correlation between Quantitative Ultrasound Characteristics and Dual Energy X-ray Absorptiometry
Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various methods for measuring bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) has proven so far to be reasonably precise (about 1% to 2%) and accurate...
Original Article
Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia
Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously studied in Singapore children; hence we report our experience with the use of adenosine for the treatment and diagnosis of supraventricular tachycardia in children over...
Review Article
Interventional Electrophysiology and its Role in the Treatment of Cardiac Arrhythmia
Cardiac arrhythmias are disorders of the electrical system of the heart which can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac death. Clinical cardiac electrophysiology is a sub-specialty in cardiology dealing specifically with the study of the electrophysiology of the heart and all aspects of management...
Review Article
A Review of the Role of Magnetic Resonance Imaging in the Evaluation of Shoulder Impingement Syndrome and Rotator Cuff Tendon Tears
In the evaluation of chronic shoulder pain and dysfunction clinically suspected to be due to shoulder impingement syndrome and rotator cuff tendon tears, magnetic resonance imaging (MRI) has virtually replaced double contrast shoulder arthrography. MRI has the advantage of demonstrating the shoulder joint in multiple anatomical planes with excellent...
Original Article
Portable Chest Radiography: Comparison of High-resolution Digital Displays with Laser Printed Digital Film
In most institutions, about 10% to 25% of imaging examinations are recorded digitally (e.g. digital subtraction angiography, computed tomography, magnetic resonance imaging and ultrasound). Conventional-projection radiographic studies are still displayed in an analog fashion (on film).
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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 the advent of modern non-invasive imaging techniques, percutaneous techniques performed under imaging guidance have, over the recent years, become increasingly acceptable as a suitable alternative...
Original Article
Contrast-Enhanced Magnetic Resonance Imaging of the Internal Auditory Canals and Posterior Fossa
Contrast-enhanced magnetic resonance imaging (MRI) is now the gold-standard examination for the exclusion of acoustic schwannomas or other posterior fossa tumours. We retrospectively reviewed 314 cases done over a period of 2 years and 9 months, correlating presenting symptoms with scan findings.
This article is available only as a PDF....
Review Article
Imaging of Thoracic Manifestations of Scleroderma
Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys, and heart. The American College of Rheumatology has proposed that for the purpose of clinical trials and surveys, the diagnosis is made if the patient...
Review Article
Overview of Imaging in Rheumatologic Diseases
Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations and advances in technology in imaging and interventional radiology today enable more precise and earlier detection, assessment and treatment.
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Others
Incessant Ectopic Atrial Tachycardia and Tachycardia-related Cardiomyopathy: Therapeutic Options and Potential for Cure
Incessant ectopic atria tachycardia (IEAT) is a rare and insidious arrhythmia which is frequently misdiagnosed and if untreated, leads to ‘exhaustion’ of the myocardium and result in tachycardia-related cardiomyopathy. Early strategies to manage this problem such as pharmacological therapy to either block the atrioventricular node or suppress the ectopic...
Review Article
Intracoronary Brachytherapy: The Beginning of the End of Restenosis?
Restenosis remains a major clinical problem 20 years after the introduction of coronary angioplasty by Andreas Gruentzig in the treatment of coronary artery disease. Recent randomised studies showed a persistent 32% to 57% incidence of angiographic restenosis following successful balloon angioplasty, usually within the first 6 months, despite increased...
Review Article
Homocysteine and Atherosclerotic Disease: The Epidemiologic Evidence
Homocysteine is a thiol-containing amino acid formed during the metabolism of methionine. The metabolic fate of homocysteine may be influenced by the alterations in the activities of serum folate, pyridoxine and cobalamin.
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Original Article
Magnetic Resonance Imaging of Brain Metastases: Magnetisation Transfer or Triple Dose Gadolinium?
Accurate detection of brain metastases is an important part of tumour staging. Magnetic resonance (MR) imaging is well accepted as a sensitive tool in the detection of brain metastases.
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Original Article
Radiological Placement of 211 Central Venous Catheters: Outcome and Complications
Long-term central venous access is an important part of modern medical practice, especially in the haematology and oncology units. Central venous (CV) catheters are used for the administration of anti-neoplastic agents, immunosuppressive drugs, antibiotics, blood components, hyperalimentation, for frequent blood sampling, and for acute and temporary haemodialysis prior to...
Others
T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report
T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T wave during sinus rhythm without any changes in the QRS complex, is an uncommonly recorded rhythm. We report here an unusual case of T wave...
Original Article
Trends in Mortality, Incidence, Hospitalisation, Cardiac Procedures and Outcomes of Care for Coronary Heart Disease in Singapore, 1991-1996
In line with trends in many high-income countries, Singapore has experienced some declines in mortality from coronary heart disease (CHD) since the 1980s. Whether this can be attributed to reduced population levels of risk factors for CHD, declining incidence and severity of disease, changes in medical care, or even...
Commentary
Tissue Microangiography Using a Simplified Barium Sulphate Cadaver Injection Technique
The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections, combined with injections to outline the blood supply.
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Original Article
Radionuclide Studies of Articular Cartilage in the Early Diagnosis of Arthritis in the Rabbit
Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis of osteoarthritis.
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Others
Retroperitoneal Castleman’s Disease in the Perinephric Space—Imaging Appearance: A Case Report and a Review of the Literature
Castleman’s disease (CD) was first proposed by Castleman in 1954. It is usually found in the mediastinum, but other sites have been described.
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Original Article
Initial Experience With an Autocapture Pacemaker System
The longevity of a pacemaker generator varies directly with the total deliverable amount of electrical charge (Q, in coulombs) and inversely with the rate of consumption of charge. The rate of consumption is dependent in turn on the total number of electrical pulses per unit time, and the strength...
Original Article
Evaluation of Technetium-99m Ciprofloxacin (Infecton) in the Imaging of Infection
Over the past 10 years we have used various radiopharmaceuticals (RPCs) for imaging of inflammation and infection. These include gallium-67 citrate and the technetium-99m labelled nanocolloids, immunoglobulin (IgG), antigranulocyte antibodies (AGAB) and HMPAO-labelled leukocytes.
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Others
The Differential Diagnosis of Supraventricular Tachycardia Using Clinical and Electrocardiographic Features
Noninvasive evaluation of the mechanism of the arrhythmia is important in the management of supraventricular tachycardia (SVT). It guides one in the choice of therapy.
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Original Article
Cardiac Marker Point-of-care Testing: Evaluation of Rapid On-site Biochemical Marker Analysis for Diagnosis of Acute Myocardial Infarction
In the present era of revascularisation therapy, rapid and accurate diagnosis of acute myocardial infarction (AMI) is important, as these patients may benefit from early intervention in the form of primary angioplasty, fibrinolysis or anti-thrombotic therapy. The most widely accepted criteria for diagnosis of AMI, laid down by WHO,...
Others
Cardiovascular Disease: Genes and Public Health
The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is assumed that the identification of mutations that confer susceptibility will provide the basis for new means of detection, prevention and treatment.
This article is available only...
Original Article
Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study
Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental or lifestyle factors that may be involved. This is aided when the ethnic groups live in the same country, so that differences in completeness and...
Original Article
Technetium-99m Sestamibi for the Assessment of Myocardial Salvage Following Reperfusion Therapy in Acute Myocardial Infarction
Reperfusion therapy for acute myocardial infarction is feasible with thrombolytic therapy as well as acute percutaneous transluminal coronary angioplasty (PTCA). Both modalities of treatment have been proven to improve long-term survival.
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Original Article
Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients
Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations, or some other less specific complaints such as nausea, pallor and sweatiness.
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Others
Diagnosis of Pacemaker Lead Infection Using Transoesophageal Echocardiography: A Case Report
The expanding indications for permanent cardiac pacing mandate an awareness of the potential complications associated with device implantation. After failure of pacing and sensing, infection is the most frequent pacemaker-related complication, with reported rates of between 1% to 7% in older studies1 and <1% in more recent series.
This article...
Original Article
Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting
The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in the fight against the disease. The safety and efficacy of these vaccines have been well demonstrated in clinical trials,1,2 and also against severe disease from...
Others
Isolated Non-compaction of Ventricular Myocardium: A Report of Three Cases
Non-compaction of ventricular myocardium is a rare morphogenic arrest of compaction of the ventricular myocardial fibres during intrauterine life. Usually, the left ventricle is more compact and less trabeculated than the right ventricle.
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Original Article
Impairment of Endothelial Function—A Possible Mechanism for Atherosclerosis of a High-fat Meal Intake
The impairment of endothelial vasodilatory function has been considered an early event in atherogenesis. This has been studied in association with various cardiovascular risk factors such as diabetes mellitus, hyperhomocystinuria, smoking, hypertension and hypercholesterolaemia.
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Original Article
A Preliminary Study of the Utility of Combined Cardiac Markers in the Evaluation of Patients Presenting Early with Suspected Acute Coronary Syndrome
The management of patients presenting with chest pain of recent onset can prove to be a diagnostic challenge. These patients vary from having atypical musculoskeletal pain, unstable angina pectoris (UAP), non-ST elevation myocardial infarction (NSTEMI), to early ST-elevation myocardial infarction (STEMI).
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Original Article
Homocysteine, Folate and Vitamin B12 as Risk Factors for Acute Myocardial Infarction in a Southeast Asian Population
Since the beginning of the last decade, hyperhomocysteinaemia has been identified as a risk factor for acute coronary syndromes. A few large prospective studies have shown a clear increase in relative risk, especially for those populations with plasma homocysteine levels above 15 µmol/L.
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Others
Magnetic Resonance Arthrography of the Labral-Ligamentous Complex of the Shoulder: An Update
Shoulder instability is a frequently encountered clinical problem in young active people following injury, particularly in athletes. The labral-ligamentous complex is increasingly recognised as being an important structural component that contributes to shoulder instability.
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Original Article
Limited Magnetic Resonance Imaging (MRI) and the Occult Hip Fracture
Worldwide, in the past decade, the application of magnetic resonance imaging (MRI) has increased tremendously in the management of musculoskeletal trauma. Not least is its application as a valuable diagnostic tool in occult hip fracture evaluation.
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Original Article
Myocardial Infarction in Singapore: A Nationwide 10-year Study of Multiethnic Differences in Incidence and Mortality
Rapid urbanisation and increasing affluence have improved the socioeconomic status of Asians. This, however, has brought with it new socioeconomic and medical problems resulting from the urbanised lifestyles entrenched in these newly industrialised economies.
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Review Article
Rheumatic Heart Diseases in Pregnancy
Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis causing chronic valvular lesions. Severe myocardial and pericardial involvements are much less common.
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Others
Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports
Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up to 3 months) after starting allopurinol.
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Original Article
Technetium-99m Methoxyisobutylisonitrile Imaging in the Follow-up of Differentiated Thyroid Carcinoma
Differentiated thyroid carcinoma (DTC) is not an uncommon tumour in Thailand.1 A high percentage of 10-year survival results in long-term follow-up. I-131 total-body scan (I-131 TBS) is commonly used for monitoring the disease after surgery and radioiodine ablation in most centres.
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Others
Two Case Reports on Incessant Left Ventricular Tachycardia: Curative Therapy with Radiofrequency Ablation
Left ventricular tachycardia is a recognisable condition in patients with otherwise structurally normal heart. It may arise from various foci in the left ventricle.
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Others
Embolisation of a Renal Artery Pseudoaneurysm in a Patient with Renal Malrotation and Chronic Aortic Dissection
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.
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Review Article
Prevention of Restenosis after Percutaneous Coronary Intervention: The Continuing Challenge
Since Andreas Gruntzig first demonstrated its use in humans in 1977, the utilisation of percutaneous transluminal coronary angioplasty (PTCA) has grown tremendously throughout the world today. The ability to treat coronary artery stenosis with this minimally invasive alternative to coronary artery bypass surgery is attractive to both cardiologists and...
Original Article
Single Centre Review of Radiologically-guided Percutaneous Nephrostomies: A Report of 273 Procedures
Percutaneous nephrostomy (PCN) is a well-established technique in the armamentarium of an interventional radiologist when dealing with urinary obstruction. It provides temporary relief in obstructive uropathy and stabilises the patients for subsequent definitive treatment.
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Original Article
To Establish the Normal Bone Mineral Density Reference Database for the Singapore Male
Bone mineral densitometry was developed as a means to quantify the bone mineral content of the skeleton accurately and has been used in the diagnosis of osteopenia and osteoporosis. Dual-energy X-ray absorptiometry (DXA) of the axial skeleton is one such technique2 which is based on a subtraction method.
This article...
Original Article
Percutaneous Vertebroplasty in the Management of Osteoporotic Vertebral Compression Fractures: Initial Experience
With the general increase in life expectancy in the local population, the incidence of osteoporosis is anticipated to rise as well. Even with screening modalities such as bone mineral densitometry and preventive treatment such as hormone replacement therapy, many patients are asymptomatic and are diagnosed with osteoporosis only after...
Original Article
Differentiation of Malignant Vertebral Collapse from Osteoporotic and Other Benign Causes Using Magnetic Resonance Imaging
An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult to differentiate between benign and malignant causes for the vertebral collapse.
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Letter to the Editor
Letter to the Editor
We would like to draw the attention of your readers to the comments made in the editorial of the recent Imaging issue of your journal.
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Others
Imaging-guided Bone Biopsy
Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety of modalities, such as fluoroscopy1 and computed tomography (CT), and less commonly, ultrasonography (US) and magnetic resonance (MR) imaging.
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Others
Carcinoma of the Cervix: Role of MR Imaging
In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each year in both developing and industrialised nations, with a higher incidence in women of low socioeconomic status.
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Others
Intracerebral Schwannoma—A Rare Cause of Epilepsy
Schwannomas are extra-axial neoplasms derived from the nerve sheath of peripheral or cranial nerves. They represent approximately 8% of all intracranial tumours, arising predominantly from the vestibular nerve.
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Others
Radiographic Features of a Case of Severe Acute Respiratory Syndrome with Fatal Outcome
Severe acute respiratory syndrome (SARS) is an atypical pneumonia that was first reported in early 2003. Reports of outbreaks of cases rapidly appeared in Hong Kong, Vietnam, China and Singapore.
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Others
Clinical Applications of MR Cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) has attracted a lot of interest from clinicians because it is a non-invasive method of obtaining a cholangiographic image without the morbidity that is associated with endoscopic retrograde cholangiopancreatography (ERCP).
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Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children.
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Review Article
Clinical Positron Emission Tomography Imaging—Current Applications
Like other radionuclide techniques, positron emission tomography (PET) is based on the tracer principle – a small amount of labelled ligand is used to trace the metabolic pathway of an important chemical in the cell. PET complements anatomic imaging by its ability to map function or metabolism.
This article is...
Review Article
MR Imaging and MR Spectroscopy of Adenocarcinoma of the Prostate
Prostate cancer is usually suspected due to an abnormal digital rectal examination, elevated serum prostate specific antigen (PSA) level or both. The diagnosis of prostate cancer depends on histopathologic examination of tissue obtained from systematic sextant core needle biopsy under transrectal ultrasound guidance.
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Review Article
Imaging of Congenital Middle Ear Deafness
When a child or young adult with morphologically normal external ears and no previous history of ear discharge or trauma presents with conductive hearing deficit, a congenital middle ear anomaly should be sought. Although fenestral otosclerosis is a differential diagnosis, the early onset of symptoms and a lack of...
Review Article
MR Imaging of the Fetal Brain and Spine: A Maturing Technology
The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.
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Review Article
Imaging of Acquired Immunodeficiency Syndrome (AIDS)
The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of death worldwide. There are now 60 million deaths recorded from the infection worldwide by the United Nations AIDS (UNAIDS) organisation, most of them in sub-Saharan...
Review Article
The Singapore National Breast Screening Programme: Principles and Implementation
In January 2002, the first population-based national mammographic breast screening programme in Asia, the Singapore National Breast Screening Programme (BreastScreen Singapore), was launched. The programme aims to achieve international standards of breast screening practice and breast cancer detection, as well as to reduce or stabilise the mortality from breast...
Original Article
Brachiocephalic-Superior Vena Cava Metallic Stenting in Malignant Superior Vena Cava Obstruction
A large majority of superior vena cava (SVC) syndrome is caused by malignancy (74% to 95%). This can either be due to direct SVC invasion or secondary to extrinsic compression.
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Original Article
Pilot Study Using Technetium-99m Pertechnetate Sequential Radionuclide-Sialography to Assess Salivary Gland Function in Nasopharyngeal Cancer Patients on Radiation Therapy
Nasopharyngeal carcinoma (NPC) is an epithelial malignancy occurring worldwide with particularly high frequencies in the Far East. The incidence is highest in Hong Kong followed by Singaporean Chinese.
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Original Article
Breath-hold Fast Recovery Fast Spin Echo versus Conventional Non-Breath-hold Fast Spin Echo T2-Weighted MR Imaging of Focal Liver Lesions
T2-weighted magnetic resonance (MR) imaging is an important sequence for characterisation of focal liver lesion. Accurate characterisation of benign lesions, such as haemangioma or cyst, is important to prevent unnecessary procedure or surgery.
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Original Article
Diffusion-weighted MR Imaging in Intracranial Infections
Diffusion-weighted magnetic resonance (MR) imaging (DWMRI) is becoming essential to the assessment of acute cerebral infarction and has also been applied to distinguish cerebral abscess from necrotic intracranial neoplasm. There have also been a few case reports on DWMRI of encephalitis.
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Original Article
Preoperative High Resolution CT and MR Imaging in Cochlear Implantation
Candidates for cochlear implantation undergo a thorough audiological and medical assessment. The audiological assessment is done to ensure that these candidates who have bilateral profound or severe hearing loss have been given adequate hearing amplification, but show no significant benefit.
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Original Article
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of the mammogram remains the basic policy, as was recommended in the Forrest report.
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Original Article
Breast Cancer in Women Under 40 Years: Preoperative Detection by Mammography
The incidence of breast cancer peaks between the ages of 45 and 55 years. Approximately 7% of breast cancers occur below 40 years of age.
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Editorial
The Past Decade of Diagnostic Radiology in Singapore: How Much Progress Have We Really Made?
It has been 10 years since the first ever issue of Annals dedicated to “Radiology” was published in Volume 22 No. 5 September 1993. Keeping in mind the tremendous growth in the development and applications of Imaging for both Diagnosis and Intervention, this second theme issue is long overdue.
This...
Others
A Case Series of Sotalol-induced Torsade de Pointes in Patients with Atrial Fibrillation – A Tale with a Twist
In the light of the Cardiac Arrhythmia Suppression Trial (CAST) which suggested that class I antiarrhythmics may be linked to an increase in mortality, attention has been turned towards the use of class III drugs for the management of both atrial and ventricular arrhythmias. While the adverse effects of...
Review Article
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
Colorectal cancer is the second most common cancer in Singapore, accounting for 15.9% of all cancers registered with the Singapore Cancer Registry in the years between 1993 and 1997. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer.
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Original Article
Computed Tomographic Appearance of Colorectal Hepatic Metastases
It is important to recognise the computed tomography (CT) appearance of hepatic metastases from colorectal primaries, as resection in a selected group may offer a 20% to 40% rate of five-year survival compared to 5% to 10% with non-surgical management.
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Review Article
Current Status in Imaging of Colorectal Liver Metastases
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the time of clinical presentation, with an additional 30% developing clinical evidence of hepatic disease within 24 months.
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Others
Routine Abdominal and Pelvic Ultrasound Examinations: An Audit Comparing Radiographers and Radiologists
Since its introduction into clinical practice in the early 1970s, ultrasound (US) has become firmly established as an extremely valuable imaging modality and widely used to the extent that abdominal US is the second most commonly performed imaging study (after chest radiography). Our department has also experienced a steady...
Original Article
Immediate and Mid-Term Safety and Efficacy of Single Lead VDD Pacemakers for Patients with Atrioventricular Block and Normal Sinus Node Function—A Single Centre Experience
In patients requiring a cardiac pacemaker for any indication, the ideal goal of therapy is to achieve atrioventricular (AV) synchrony. This replicates the normal cardiac contraction sequence and is better tolerated with fewer associated complications in the long term.
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Original Article
Clinical Utility of Selective Intra-arterial Calcium-stimulated Hepatic Venous Sampling in Regionalisation of Insulinomas—The Singapore Experience
Insulinomas are small tumours with dimensions that seldom exceed 2.0 cm in diameter. Preoperative non-invasive localisation using trans-abdominal ultrasound and conventional computed tomography (CT) detect only between 25% and 60% of insulinomas.
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Images in Medicine
Torsades de pointes in a woman presenting with syncope
A 57-year-old woman presented with first onset syncope, which was witnessed by her family members. It occurred in the middle of a conversation and lasted for 30 seconds, followed by spontaneous and prompt recovery. There was upward rolling of eyeballs with no witnessed tongue biting, jerking of limbs or...
Original Article
Spironolactone Does Not Prevent Restenosis After Coronary Stenting in Humans
High restenosis rate, which has been documented to occur in approximately 30% to 50% of cases, still remains a major concern, although percutaneous transluminal coronary angioplasty can be performed with a high initial success rate and good immediate angiographic results. Early elastic recoil, late vessel remodelling, and neointimal proliferation...
Others
Reflections of a Septuagenarian – Radiology: Past, Present and Future
Before I commence, I would like to thank the Singapore Radiological Society and the Chapter of Radiologists of the Academy of Medicine for inviting me to speak today on the occasion of the inauguration of the FY Khoo Lectureship. I was initially hesitant.
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Others
Imaging Findings in Acute Neck Infection due to Pyriform Sinus Fistula
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.
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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 and spatial resolution, as well its high selectivity and ability to show the full extent of vascular disease, presence of contralateral disease, patterns of collateral...
Original Article
Breast Ultrasound in Women With Familial Risk of Breast Cancer
Mammography is the modality of choice to screen for breast cancer in asymptomatic women. However, it is known that about 10% to 12% of breast cancers are mammographically occult.
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Review Article
Nuclear Cardiology in Singapore: A Review
The past decade has witnessed significant advances and rapid growth in the field of nuclear cardiology. In Singapore, our experience has been similar to the United States, with a 10% to 15% yearly growth in volume of cardiac nuclear studies now performed at many institutions since its introduction in...
Review Article
Stem Cell Cardiomyoplasty: State-of-the-Art
Congestive heart failure (CHF) remains the most common diagnosis made in cardiology wards today. At present, no long-term therapeutic option for end-stage CHF is available except for orthotopic heart transplant.
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Review Article
Medical Therapy in Heart Failure – Is Polypharmacy Necessary?
The clinical syndrome of heart failure is recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses. Heart failure is the end-stage of all heart diseases.
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Review Article
Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging
Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there has been a dramatic increase in the survival rate of patients.
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Review Article
Drug-eluting Stents: The End of Restenosis?
Percutaneous coronary intervention (PCI) is the preferred revascularisation approach for most patients with coronary artery disease because, with comparable clinical outcomes in selected patients, PCI is less invasive and offers shorter hospital stay and faster recovery as compared to coronary artery bypass grafting (CABG). The acceptance of PCI as...
Original Article
Coronary Artery Ectasia: A Ten-year Experience in a Tertiary Hospital in Singapore
Coronary artery ectasia (CAE) is the abnormal dilatation of a segment of the coronary artery to a diameter of at least 1.5 times that of normal adjacent segments1 (Fig. 1). It is a well-recognised, albeit uncommon, finding at cardiac catheterisation.
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Original Article
Pilot Survey of the Diagnosis and Management of Heart Failure in Primary Care: A Singaporean Perspective
Congestive heart failure is an increasingly common disorder and a major cause of morbidity and mortality in developed countries around the world. It is a clinical syndrome that represents the end point of a myriad of heart conditions.
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Original Article
High-sensitivity C-reactive Protein is Predictive of Medium-term Cardiac Outcome in High-risk Asian Patients Presenting With Chest Pain Syndrome Without Myocardial Infarction
Patients with chest pain often pose a diagnostic conundrum to the attending physician especially when symptoms are not typical of angina and the electrocardiogram nondiagnostic. Troponin levels are frequently measured at presentation to prognosticate the patient.
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Editorial
Cardiovascular Medicine and Surgery in Singapore: The Next Lap
Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial were the impact of changing demographics and disease patterns, the importance of optimising resources, and the need for structured training and sub-specialisation.
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Others
A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia
Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000 deliveries.
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Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
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Original Article
Semi-Quantitative Measurements of Normal Organs With Variable Metabolic Activity on FDG PET Imaging
Positron emission tomography (PET) has a proven clinical role in oncology, cardiology and neurology that primarily uses 2-deoxy-2--fluoro-deoxyglucose (FDG). FDG is an analogue of glucose that mimics the cellular uptake and initial metabolism of glucose, which enables cells utilising excess glucose to be visualised. Increased glucose metabolism is commonly...
Review Article
The Role of FDG-PET in the Management of Non-small Cell Lung Carcinoma
Carcinoma of the lung is the leading cause of cancer death in both men and women and is the second most common malignancy in both men and women. In 2003, it is estimated that there will be 171,900 new cases of lung carcinoma diagnosed in the United States and...
Review Article
Clinical PET Imaging – An Asian Perspective
Positron emission tomography (PET) is distinct from other imaging modalities in its ability to probe the physiology and biochemistry of normal and abnormal tissues. It is based on the same principle of tracer kinetics used in conventional nuclear medicine.
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Review Article
PET Tracers and Radiochemistry
Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in large part, to advances in instrumentation and synthetic chemistry.
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Review Article
Physical Principles and Technology of Clinical PET Imaging
The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The emergence of PET as the functional imaging modality of choice for diagnosis, staging, therapy monitoring and assessment of recurrence in cancer has led to an...
Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...
Original Article
Use of D-dimer and Lower Extremity Doppler Ultrasound Results to Obviate the Need for Computerised Tomographic Pulmonary Angiography
The diagnosis of pulmonary embolism (PE) can be a challenging problem. It depends on clinical suspicion and the interpretation of a combination of clinical and radiological presentations.
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Original Article
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Radiofrequency (RF) ablation for the treatment of focal liver malignancies is a relatively new image-guided procedure that is gaining increasing acceptance in the radiologic and surgical community, particularly as an alternative treatment option for patients who have inoperable tumours. The potential benefits of minimally invasive image-guided ablation, as compared...
Others
16th Seah Cheng Siang Memorial Lecture – The Changing Face of Cardiology Practice, Training and Research in Singapore
Professor Seah Cheng Siang was one of the most illustrious physicians of his era. During his professional career, he held the following positions: Head, Department of Medicine, Thomson Road General Hospital (1960-71); Head, Department of Medicine III at the Singapore General Hospital (1971-87); Master of the Academy of Medicine...
Editorial
Building Collaboration in Cardiac Imaging
Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery disease (CAD) detection has captured the imagination of the public appears exceptional.
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Others
3rd FY Khoo Memorial Lecture – Education, Professionalism, Outsourcing and the Future of Radiology
Radiology is undergoing unprecedented changes. Not only is the technology evolving rapidly, providing images of breathtaking anatomical clarity, but functional information has also become a reality.
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Review Article
Singapore National Medical Image Resource Centre (SN.MIRC): A World Wide Web Resource for Radiology Education
Radiological images are critical for diagnosis, teaching and research. In radiology education, learners must be exposed to large amounts of visual information, and assimilation of these medical images is essential in the training of diagnostic skills.
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Review Article
Teleradiology in Singapore – Taking Stock and Looking Ahead
Teleradiology is the electronic transmission of radiologic images from one location to another for the purposes of interpretation and/or consultation. The current interest in teleradiology is fuelled mainly by rapid technological advances, a worldwide shortage of radiologists, and cost considerations in developed countries.
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Original Article
Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore
Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection from close contact.
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Others
Guidelines on Cardiac CT in Singapore (2006)
The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice computed tomography (CT) technology such as thin detector collimation and fast gantry rotation allow the heart to be scanned in a single breath-hold.
This article is...
Others
A Case of Cystic Schwannoma of the Lesser Sac
Schwannoma or neurilemmoma (NL) is a well-defined, usually benign, tumour arising from the nerve sheath (Schwann cell). It may present as a solitary mass in any part of the body, but is more commonly seen in the head and neck, the extremities and on the trunk.
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Original Article
The Association of Smoking with Components of the Metabolic Syndrome in Non-diabetic Patients
Metabolic syndrome (MS) is conceptualised as a constellation of physiologic or anthropometric abnormalities. Typically, it includes excess weight, hyperglycaemia, elevated blood pressure, low concentration of high-density lipoprotein cholesterol (HDL-C), and hypertriglyceridaemia.
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Original Article
Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis
Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused by atherosclerosis. Atherosclerosis (the hardening of the arteries) is the most common form of arteriosclerosis, in which the walls of arteries become thicker and less...
Original Article
Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients
Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately 2.2%.
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Original Article
Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative
Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms of its ability to achieve higher patency rates, minimise infarct size, improve left ventricular function and improve long-term survival, as well as lower rates of...
Original Article
Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry
Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death.
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Others
Magnetic Resonance Imaging of Sports Injuries of the Knee
Sports-related knee injuries are common, with contact sports and sports involving twisting movements being the most frequent causes. Sports injuries may affect any of the knee structures, including ligaments, menisci, bones, cartilage and periarticular soft tissues.
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Letter to the Editor
Non-compaction Cardiomyopathy Presenting with Classical Angina Pectoris
Non-compaction cardiomyopathy (NCC) is an unclassified cardiomyopathy, previously known as “spongy left ventricular myocardium”. It is characterised by prominent myocardial trabeculations and deep intertrabecular recesses which lie in continuity with the left ventricular cavity.
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Letter to the Editor
A Case of Myopericarditis in a Patient with Methicillin-resistant Staphylococcus aureus Community-acquired Pneumonia
We described a healthy and physically active 41-year-old man who presented to a private practitioner with right axillary pain and fever. Physical examination revealed a right axillary fluctuant lump consistent with an abscess that was subsequently drained.
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Original Article
The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow
Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram. Many aetiological factors, such as microvascular and endothelial dysfunction, have been implicated.
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Commentary
Improving Access to Outpatient Cardiac Care at the National Heart Centre – A Partnership Between Specialists and Primary Care
There is evidence that shows that the use of healthcare delivered by private providers, particularly procedures and hospital care, depends on supply. For example, in a population-based study of patients with pain that might signal arthritis of the knee, the number of patients in need of surgery (physicians determined...
Original Article
Pattern and Outcome of Subsidised Referrals to Cardiology Specialist Outpatient Clinics
Singapore faces an increasing demand for public healthcare from an ageing population in need of chronic care. At our cardiology specialist outpatient clinics, the volume of new cardiology subsidised outpatients has increased at an average of 12.8% per annum for the past 10 years.
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Letter to the Editor
Phaeochromocytoma the Great Mimicker: A Case Report
Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule of 10” where 10% are extra-adrenal, of which 10% are extra-abdominal, 10% are malignant, 10% occurs in normotensive patients and 10% are hereditary.
This article is...
Original Article
The Angiographic Aspects of Myocardial Bridges in Turkish Patients who have Undergone Coronary Angiography
Myocardial bridge, intramural coronary artery, coronary artery over bridging and myocardial loop are essentially the different terms used to designate the same phenomenon. Myocardial bridge was first described by Reyman in 1737 as an anatomical curiosity – the overlaying of the left anterior descending coronary artery by a myocardial...
Original Article
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian countries.
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Review Article
Management of Acute ST-Elevation Myocardial Infarction: Reperfusion Options
Cardiovascular disease is a leading cause of death globally. More than 920,000 myocardial infarctions (MI) are diagnosed annually in the United States. Of these, about 500,000 ST-elevation myocardial infarctions (STEMI) are estimated to occur each year.
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Letter to the Editor
A Case of Acute Myocardial Infarction 24 hours after Acute Ischaemic Stroke
It is well known that thrombolysis for acute myocardial infarction (AMI) may lead to disintegration of pre-existing intracardiac thrombi with subsequent cerebral embolisation. It appears plausible that the same mechanism could apply to patients with cardiac or arterial thrombi who are undergoing intravenous thrombolysis for acute ischaemic stroke.
This article...
Letter to the Editor
Medical Misadventure: Barium Extravasation in Colorectal Cancer
Double contrast barium enema (DCBE) is a safe and accurate diagnostic procedure for colorectal cancer. It is often the next diagnostic test after incomplete colonoscopy, with an additional diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the non-visualised portion of the colon.
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Letter to the Editor
Durian Seed Masquerading as Gallstone Ileus on Computed Tomography
Bezoars and gallstones are unusual causes of small bowel obstruction, with well-described imaging features on CT. We present a case of intestinal obstruction caused by a laminated mass in the terminal ileum that resembled a gallstone on CT, but was surgically proven to be a durian seed phytobezoar.
This article...
Original Article
A Survey of Local Preclinical and Clinical Medical Students’ Attitudes towards Radiology
Radiology is not a popular specialty for undergraduate student electives or postgraduate training amongst students from a local undergraduate medical school which is based in Southeast Asia. During the last 2 years (2007 & 2008), none of our elective students came from the local undergraduate medical school. During the...
Editorial
The Growing Burden of Cardiovascular Disease: Role of the Arterial-Cardiac Interaction
World Heart Day was inaugurated to increase global awareness that cardiovascular disease (CVD) is the world’s leading cause of death, claiming, according to the World Heart Federation website, 17.1 million lives each year. Control of risk factors such as hypertension, diabetes mellitus, dyslipidemia, tobacco use, and physical inactivity, are...
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.
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Letter to the Editor
Comparison of Cardiac Output Measurement by Arterial Waveform Analysis and Pulmonary Artery Catheter in Mitral Stenosis
Cardiac output (CO) is a vital measurement that influences clinical decision-making. Although thermodilution via a pulmonary artery catheter (PAC) is considered the gold standard for CO monitoring, the use of the PAC is no longer routine given its associated complications and lack of efficacy data.
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Images in Medicine
Unusual Pacemaker Lead Placement in an Unsuspecting Heart
A 51-year-old man, with a negative cardiac medical history, presented with symptomatic 2:1 atrioventricular block. A permanent pacemaker was implanted.
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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...
Letter to the Editor
Embolised Injection Needle Fragment to the Heart, Mimicking a Subcutaneous Charm Needle
Embolisation of a fragmented injection needle to the heart is rare, even in intravenous drug abusers. The presence of an embolised needle fragment to the heart can serve as a nidus for infective endocarditis.
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Original Article
Central Clot Score at Computed Tomography as a Predictor of 30-day Mortality after Acute Pulmonary Embolism
Multi-detector Computed Tomography (MDCT) pulmonary angiography is currently the method of choice for the detection of acute pulmonary embolism (PE), because of its convenience, speed, sensitivity, direct clot visualisation and ability to provide alternative diagnoses that mimic PE clinically.
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Original Article
Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?
Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of devices has been developed for use over the years, with significant advances achieved in terms of profile and safety.
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Original Article
Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients
The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in which there are pathologies in the vessels nourishing the brain. Besides being a serious health problem due to its high mortality and morbidity, stroke is...
Original Article
Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis
Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the more diffuse and accelerated form of atherosclerosis and endothelial dysfunction which lead to diffuse coronary lesions, small vessel disease, multi-vessel involvement, larger plaque burden as...
Original Article
Risk Factors and Clinical Outcomes for Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients with Normal Serum Creatinine
Contrast-induced nephropathy (CIN) is a common complication post-percutaneous coronary intervention (PCI). CINis associated with increased morbidity, mortality, prolonged hospitalisation and long-term renal impairment.
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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 even direct puncture of the aorta from a translumbar approach, have been utilised in the past.
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Others
Angioplasty on an Infarct-related Anomalous Right Coronary Artery Arising from Posterior Coronary Sinus
A 60-year-old chronic smoker had delayed presentation (>18 hours) of acute inferior myocardial infarction with electrocardiogram showing 1.0 mm ST-segment elevation in leads II, II, and aVF on admission to hospital. Subsequently, he developed sustained complete atrioventricular block with no ventricular escape which necessitated temporary pacing.
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Others
Complete Atrioventricular Block Complicating Acute Anterior Myocardial Infarction can be Reversed with Acute Coronary Angioplasty
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.
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Review Article
Acute Myocardial Infarction in Pregnant Women
Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. It typically occurs in middle-aged or elderly people with cardiovascular risk factors, such as cigarette smoking and diabetes mellitus. Although uncommon, AMI does occur in pregnant women. From the physiological perspective, pregnancy has been shown to...
Review Article
Risk Stratification for Sudden Cardiac Death after Acute Myocardial Infarction
In today’s modern era of evidence-based medicine and interventional cardiology, most patients who suffer an acute myocardial infarction (AMI) are started on medication with proven prognostic benefit and undergo coronary angiography with revascularisation as dictated by their presentation and symptoms.
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Review Article
Adjunctive Pharmacologic Agents and Mechanical Devices in Primary Percutaneous Coronary Intervention
Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI), with regard to reduction of death, stroke and re-infarction. However, bleeding and thrombotic complications can occur despite successful PPCI and slow flow/no-reflow or poor microvascular reperfusion...
Review Article
Management of Antiplatelet Therapy During Acute Percutaneous Coronary Intervention: New Strategies and Therapeutics
Platelet adhesion, activation, and aggregation are stimulated during an acute coronary syndrome (ACS), the result of intimal injury due to rupture of an atherosclerotic plaque. This triggers a cascade of events leading to the catastrophic formation of an occlusive clot. Antiplatelet agents assume the cornerstone role in modern pharmacotherapy...
Review Article
Risk Assessment Models in Acute Coronary Syndromes and Their Applicability in Singapore
Strategies for managing cardiovascular disease are evolving rapidly. This evolution and improvement in care is responsible for reducing mortality especially in patients presenting with acute coronary syndromes (ACS). Nevertheless, there is room for further improvement in outcomes, particularly amongst high-risk patient subgroups in this population.
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Review Article
Current Trends in Diagnostic Biomarkers of Acute Coronary Syndrome
Advances in our understanding of the pathophysiology of acute coronary syndrome (ACS) have led to the marked increase in development of biomarkers for diagnosis, risk stratification, therapeutic decision-making, and assessment of clinical outcomes. Patients with ACS are subdivided into the following 2 major categories based on the 12-lead electrocardiogram...
Review Article
Update on Clinical Imaging of Coronary Plaque in Acute Coronary Syndrome
Acute coronary syndrome (ACS) encompasses the clinical spectrum of unstable angina (UA) and acute myocardial infarction (AMI). Most ACS are precipitated by luminal thrombi within coronary arteries, which may arise from 3 different atherosclerotic plaque morphologies: plaque rupture, plaque erosion or calcified nodules.
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Review Article
Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion
Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for a physician not to consider it as a possible diagnosis in any patient presenting with acute symptoms of chest tightness or discomfort, palpitations, dyspnoea, diaphoresis,...
Review Article
Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?
In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence suggests the presence of interactions between the immune system, the central nervous system (CNS) and the endocrine system, where these systems can be influenced by...
Original Article
Clinical and Angiographic Findings of Complete Atrioventricular Block in Acute Inferior Myocardial Infarction
Complete atrioventricular block (AVB) complicates inferior wall myocardial infarction (MI) in 11% to 15% of cases. It usually clusters with conditions indicative of poor clinical status, such as right ventricular infarction, cardiogenic shock, and atrial fibrillation, probably related to its association with a larger infarct size.
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Original Article
Reperfusion Strategy and Mortality in ST-Elevation Myocardial Infarction among Patients with and without Impaired Renal Function
Randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fi brinolytic therapy in the treatment of ST-segment elevation myocardial infarction (STEMI) patients with normal renal function. Practice guidelines consider primary PCI as the preferred reperfusion strategy for patients presenting with STEMI, conditional upon timely...
Original Article
Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes – Does it Still Exist in Contemporary Practice?
Globally, cardiovascular disease (CVD) is the single most common cause of death among women; and in parallel with an increasing life expectancy, the proportion of women who have CVD is also rising. Registry data demonstrate that women tend to be 10 years older than men at the time of...
Original Article
The Impact of Gender on the Outcomes of Invasive versus Conservative Management of Patients with Non-ST-Segment Elevation Myocardial Infarction
Recent studies have suggested differences in clinical outcomes between men and women following acute myocardial infarction (AMI). Some studies have indicated poorer survival of female AMI patients on admission and short-term follow-up, whilst others have shown no difference in outcome. Poorer outcome was often attributed to less aggressive management...
Original Article
Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study (FHS) cohort and was designed to predict 10-year risk of hard coronary events, including mortality due to coronary heart disease and non-fatal myocardial infarction (MI)...
Editorial
Acute Coronary Syndrome: from Epidemiology to Treatment
The term “acute coronary syndrome” (ACS) was introduced a decade ago to describe a spectrum of conditions resulting in acute myocardial ischaemia. It comprises unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment myocardial infarction (STEMI).
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Original Article
Off-Pump versus On-Pump Coronary Artery Bypass Procedures: Postoperative Renal Complications in an Asian Population
To date, the major part of routine cardiac surgery is performed using extracorporeal circulation with cardioplegic arrest. Regardless the technique of cardioplegia, temporary renal dysfunction can be observed frequently. Renal dysfunction requiring dialysis occurs in less than 5% of the patient undergoing cardiac surgery with cardiopulmonary bypass.
This article is...
Images in Medicine
Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?
A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron
emission tomography/computed tomography (PET/CT) for staging. Figure 1 demonstrates a whole body maximal intensity projection image while Figures 2 and 3 show cross-sectional images through the elbows...
Images in Medicine
Catheter Entrapment During Cardiac Electrophysiology Study
A 50-year-old man underwent cardiac electrophysiology study for palpitations. Under fluoroscopic guidance, 1 deflectable decapolar and 2 quadripolar diagnostic catheters
were introduced smoothly into the right femoral vein and up the inferior vena cava (IVC) till the level of the right diaphragm. Using biplane fluoroscopic views at left anterior
oblique 30...
Letter to the Editor
Treatment of Coronary In-stent Restenosis with Drug-eluting Balloon Catheter: Real-world Outcome and Literature Review
Dear Editor,
Currently, coronary stent implantation is employed in approximately 90% of percutaneous coronary intervention (PCI) cases. Despite the use of drug-eluting stents (DES), coronary in-stent restenosis (ISR) remains an Achilles’ heel of PCI and can occur in about 10% of patients in the real-world population. We explored the efficacy...
Original Article
Electrocardiograph Changes, Troponin Levels and Cardiac Complications After Orthopaedic Surgery
Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is as high as 10% to 26% at 6 months and cardiac-related death are common. Cardiac injury is potentially treatable and therefore early detection of myocardial...
Original Article
Long-term Outcomes of Medical Therapy Versus Coronary Revascularisation in Patients with Intermediate Stenoses Guided by Pressure Wire
Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram that offers no information on the functional significance of a coronary lesion. It is difficult to define the haemodynamic significance of a stenosis from the...
Images in Medicine
Chest Pain, Something is Not Right…Or Left
A 46-year-old female was referred for evaluation of central chest pain unrelated to exertion. She was known to have diabetes mellitus, hypertension, and dyslipidaemia. Physical examination, routine blood investigations, electrocardiogram and chest radiograph were unremarkable. Stress myocardial perfusion imaging demonstrated normal perfusion of the left ventricle (LV) with no...
Letter to the Editor
Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy—The Way Forward
I read with great interest the recent article published in the Annals of Academy of Medicine Singapore entitled, ‘Surgeon-Performed Ultrasound-Guided Fine Needle Aspiration Cytology (SP-US-FNAC) Shortens Time for Diagnosis of Thyroid Nodules, Ann Acad Med Singapore 2014;43:320-4’. Indeed, ultrasound-guided fine-needle aspiration (US-FNA) is an exceptionally valuable and simple approach...
Original Article
Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms
Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS) that affect quality of life and it causes structural and functional changes in the bladder. Previous clinical guidelines had emphasised on managing symptoms; however current...
Original Article
Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?
The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...
Letter to the Editor
A Follow-up Longitudinal Survey on a Cohort of Undergraduate Medical Students’ Attitudes towards Radiology
As a follow-up to an earlier study comparing the attitudes of first year undergraduate medical students following the introduction of a new radiology curriculum in 2008 with their clinical seniors who did not have an early exposure to radiology; we again surveyed this same cohort of first year students...
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 AF,1 which increases with age, is 8% in people aged over 80. About three-quarters of the cases are non-valvular AF. The risk for stroke in...
Original Article
Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service
Early reperfusion of ST-segment elevation myocardial infarction (STEMI) has been shown to result in better outcomes,1-3 and guidelines for treatment of STEMI recommend a rapid and coordinated response.4 The American Heart Association guidelines released in 2014 recommend a door-to-balloon (DTB) time of less than 90 minutes,5 and timings of...
Commentary
Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging
Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit into various tissues and organs, the process invariably leads to organ dysfunction. Deposition of amyloid fibrils into the heart results in cardiac amyloidosis (CA). Manifestations...
Original Article
New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore
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...
Commentary
ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series
Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well as abnormal platelet activation, impaired fibrinolysis, and endothelial dysfunction in COVID-19 patients, resulting in thrombosis. The lungs are thought to be the epicentre of thrombosis,...
Editorial
Medical management of PAD: Expand or consolidate?
In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management of patients with peripheral arterial disease (PAD). It is easy, upon meeting a patient, to prescribe appropriate medication in an outpatient setting and believe that...
Letter to the Editor
Dynamic mitral regurgitation treated with MitraClip
The dynamic nature of mitral regurgitation (MR) has been well appreciated but clinically under-recognised. In addition, evidence on therapeutic options for dynamic MR has been lacking. We report the case of a 48-year-old woman who underwent coronary revascularisation and extra-corporeal membrane oxygenation support after post-operative cardiac collapse from left...
Letter to the Editor
Percutaneous paravalvular leak repair for severe aortic regurgitation after transcatheter aortic valve implantation (TAVI)
Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous PVL closure has become increasingly performed and is an alternative to surgery.1 PVLs occur more frequently after transcatheter aortic valve implantation (TAVI), as the transcatheter...
Original Article
Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation
Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there are variations in the reported survival-to-hospital discharge rates among different regions in the world. In Singapore, OHCA incidence rate was 27.2 per 100,000 person-years, with...
Letter to the Editor
Cerebral venous thrombosis in a patient with mild COVID-19 infection
Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular coagulation, especially in patients with severe COVID-19 infection. Nauka et al. provided vital insight that thrombotic complications can happen in a patient with non-critically ill...
Original Article
The Effect of Fenofibrate on Insulin Sensitivity and Plasma Lipid Profile in Non diabetic Males with Low High Density Lipoprotein/Dyslipidaemic Syndrome
Hyperinsulinaemia and insulin resistance have been postulated to relate directly to both hypertension and coronary artery disease in type II diabetes and possibly also in those with the dyslipidaemic syndrome as first described by Reaven. This syndrome (also known as Syndrome X in endocrinology) comprises of some or all...