Medications for Parkinson’s disease (PD) is effective for several years, but is followed by motor fluctuations, dyskinesias and progression of bradykinesia and rigidity. This is the reason why surgical therapies for PD have enjoyed a resurgence of interest. This article is available only as a PDF. Please click on “Download...

Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular ionic shift from acid-base anomalies and tissue trauma. We report a rare and erstwhile unencountered cause of serum hyperkalaemia in our intensive care unit (ICU),...

Diabetes insipidus (DI) is a syndrome characterised by the excretion of abnormally large volumes of dilute urine. It occurs uncommonly in neurosurgical patients, but is an important complication. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Trauma is the fifth commonest cause of death in Singapore. In 1996, trauma contributed to 5.4% of mortality. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Ingested foreign bodies are a common condition in the practice of Otolaryngology. In particular, there is no doubt a greater tendency in the local community to consume fish without it being de-boned. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations as well as a plethora of autoantibodies in the sera of patients. The clinical features of SLE vary in different population groups. Ethnic and genetic...

The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply is from the deep penetrators from the middle cerebral and anterior cerebral arteries. This article is available only as a PDF. Please click on “Download PDF”...

Acoustic neuroma (vestibular schwannoma) patients have greatly benefited from technical advances in neurosurgery. In fact, the evolution of acoustic neuroma surgery is a microcosm of the development of neurosurgery overall. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The outlook for sufferers of severe head trauma is extremely poor. Some 20% of patients died before significant treatment can be administered, and nearly one quarter of patients end in a vegetative state with little potential for further progress. This article is available only as a PDF. Please click on...

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients with minimal change nephrotic syndrome and lupus nephritis. For those patients who failed to respond, they were treated with oral cyclophosphamide. This article is available only...

Fractures of the atlas comprise approximately 25% of all injuries to the atlanto-axial complex, 10% of all injuries of the cervical spine, and about 2% of all spinal injuries. Four-part burst fractures of the atlas were first described by Jefferson in 1920. This article is available only as a PDF....

Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes associated with intubation, the frequency and magnitude of the changes associated with extubation are less well documented. This article is available only as a PDF. Please...

Neurointensive care has come into being in the past decade as a recognised subspecialty. Pioneering neurointensivists in the United States, such as Allan Ropper and Dan Hanley, have led in demonstrating the specialised expertise that neurointensivists offer to critically ill patients. This article is available only as a PDF. Please...

Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying their acute medical problems. New interventions have been introduced with success determined by their ability to save lives. This article is available only as a PDF....

Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly so in the specialty of intensive care where intensivists possess the necessary knowledge and tools to prolong life in many situations where patients would previously...

Preoperative shaving for cranial neurosurgical procedures, as recommended in textbooks, is still a traditional practice in Singapore. Hair has been associated with uncleanliness and its removal, particularly by shaving, has been associated in the minds of practitioners and the public with cleanliness and reducing the risk of infections. This article...

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

Cleidocranial dysplasia is an autosomal dominant skeletal disorder characterized by short stature, brachycephaly, delayed closure of the fontanelles and sutures, Wormian bones, midface hypoplasia, unerupted teeth, supernumerary permanent teeth, aplasia or hypoplasia of the clavicles, and other skeletal anomalies, such as hypoplastic iliac wings and brachydactyly. This article is available...

Trauma represents a leading cause of death globally, and post-traumatic haemorrhage accounts for 40% of early mortality in spite of recent improvements in modern trauma care.1 Post-traumatic haemorrhage occurs primarily from direct injury to blood vessels, leading to exsanguination and hypovolaemic shock depending on the type and calibre of...

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. This article is available only as a PDF. Please click on “Download PDF” on...

Trauma remains the fifth most common cause of death in Singapore; it contributed 6.7% of mortality in 2001. Head injury contributes to a significant proportion of patients who die from trauma. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via mainland China. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Heterotopic ossification (HO) is the abnormal formation of bone in soft tissue outside of the skeleton. The incidence of HO has been known to occur after spinal cord injury, traumatic brain injury and after hip and knee arthroplasty. This article is available only as a PDF. Please click on “Download...

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

Recognising that severe head injury is a major health problem with significant mortality and morbidity, numerous epidemiological and outcome studies have been conducted in order to devise effective preventive measures and, allocation of resources, and for the prognostication for healthcare planning. Patients presenting with severe head injury are...

Historically, surgery for intractable epilepsy was performed with the patient awake for at least some part of the procedure to facilitate cortical mapping and satisfactory, safe excision of the epileptogenic focus. Awake craniotomy for resection of brain tumours is a less common but increasingly performed operation. While the availability...

Spinal cord injury (SCI), whether of traumatic or non-traumatic aetiology, often results in significant and catastrophic dysfunction and disability. It physically and psychologically affects not only the individual, but also the family and society. Early rehabilitation in an organised multidisciplinary SCI care system has been shown to be beneficial,...

Strokes in childhood are generally considered to be rare with an incidence of about 2.7 per 100 000 children per year.1 The aetiologies of stroke in children differ considerably from adults and multiple risk factors commonly co-exist. A large stroke registry in North America reported that a large proportion...

The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...

Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...

Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been increasing. Since 1982, malignant cancers have been the leading cause of death in Taiwan. This article is available only as a PDF. Please click on “Download...

Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case of glioblastoma multiforme (GBM) in pregnancy in which the patient underwent emergency craniotomy and adjuvant radiotherapy before delivering a healthy baby with good outcome. This article...

Singapore is a country of high income with a low level human immunodeficiency virus (HIV) epidemic, the yearly incidence of disease currently standing at 121.7 new infections per million population per year. Certain features of Singapore’s HIV epidemic are notable. Firstly, despite active screening programmes amongst high-risk populations and...

Male breast cancer is a rare disease entity, traditionally said to represent <1% of all diagnosed breast cancers. Recent statistics, however, suggest that its incidence may be on the rise, although the clinical significance of this is unknown. This rarity has precluded large randomised controlled trials, and most treatment...

Prostate cancer (PCa) is the second most frequently diagnosed cancer in men, with a worldwide incidence of approximately 900,000 in 2008. Internationally, there is marked variation in incidence, ranging from 104.2 per 100,000 in some Western populations, to 4.1 per 100,000 in South and Central Asia. However, there has...

Manifestations of the coronavirus disease 2019 (COVID-19) span a wide clinical spectrum, from asymptomatic carriers to critical illness with a wide range of complications. Our understanding of the pathophysiology of the disease process is still evolving. As part of the host response to viraemia, it has been postulated that...

The current coronavirus disease 2019 (COVID-19) pandemic has exerted significant strain on healthcare worldwide. Mostly asymptomatic or mildly symptomatic, COVID-19 caused by SARS-CoV-2 is described as a thrombo-inflammatory syndrome,1 with severe respiratory illness occurring in about 13% of affected patients. This can rapidly transform into a life-threatening condition in...

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range from USD5.9 billion–76.5 billion. Studies performed in the adult population reported that the direct cost of acute rehabilitation had been relatively similar over a 10-year...

Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...