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Perioperative emergency laparotomy pathway for patients undergoing emergency laparotomy: A propensity score matched study

Patients requiring emergency laparotomy (EL) are a vulnerable subset within general surgery, with reported 30-day mortality rates ranging from 9% to 18%, which is 3 times higher than similar elective operations.1-3 Unlike elective surgeries, the care for EL patients is time-sensitive as they move from the emergency department, radiology...

Impact of family and caregiver factors on development and behaviours in maltreated young children

Child maltreatment is defined as the neglect and abuse of children under 18 years old. It encompasses physical/emotional ill-treatment, sexual abuse, negligence and/or exploitation that causes harm to the child.1 Evidence has shown that Adverse Childhood Experiences (ACEs), such as maltreatment experienced during childhood, have a significant impact on...

Assessing the impact of frailty in elderly patients undergoing emergency laparotomies in Singapore

The ageing population is a growing global phenomenon. In 2019, 14.4% of the population in Singapore, equivalent to 3.9 million people, were aged 65 years or older.1 This percentage is expected to increase to 25% by 2030, primarily due to increased life expectancy and lower fertility rates.1 Consequently, older...

The value of frailty assessments in older surgical patients undergoing emergency laparotomies in Singapore

Mortality in emergency laparotomy (EL) far exceeds that of elective bowel surgery, and standards for the National Emergency Laparotomy Audit (NELA) in the UK were introduced due to the high mortality within 1 month of EL.1 In Singapore, 30-day mortality varies between 5.4% and 14.7% after EL.2,3 However, 30-day...

Challenges in genetic screening for inherited endocrinopathy affecting the thyroid, parathyroid and adrenal glands in Singapore

In the current landscape of medicine, it is well known that most diseases incorporate a genetic component to some degree. Genetic testing of human diseases originated in the 1950s, and screening for genetic disorders followed a decade after.1 It is worthwhile noting that the Human Genome Project (1990–2003), which...

Frailty-aware surgical care: Validation of Hospital Frailty Risk Score (HFRS) in older surgical patients

Frailty is a clinically recognisable state of vulnerability in older people, resulting from age-associated decline in physiological reserves and function across multiple organ systems, such that the ability to cope with acute stressors is compromised.1 Frailty is prevalent among older people2 and is associated with higher rates of utilisation...

Defining breast cancer-related lymphedema (BCRL) prevalence and risk factors: A pragmatic approach to lymphedema surveillance

Breast cancer-related lymphedema (BCRL) is a chronic progressive pathological condition of the lymphatic system that can lead to significant impact on the quality of life after breast cancer treatment.1 It is characterised by swelling and accumulation of protein-rich fluid in body tissues, leading to pain, tightness, skin changes such...

Breast cancer-related lymphedema (BCRL): Should we be doing more or less for the axilla?

Breast cancer mortality has declined steadily over the years with breast cancer screening, and improvement in diagnostic and therapeutic regimens. Despite cancer survivors living longer, breast cancer-related lymphedema (BCRL) is a significant complication after major breast surgery that can impact quality of life adversely. The incidence of BCRL reported...

Shock index: Easy to use, but can it predict outcomes following major abdominal emergency surgery?

Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain patient factors (e.g. advanced age, frailty, and presence of multiple comorbidities) and disease factors (e.g. perforated viscus and intra-abdominal sepsis) have been shown to predict...

Surgical margins assessment reduces re-excision rates in breast-conserving surgery

Dear Editor, Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However, BCS is associated with a higher risk for local recurrence, and published literature has reported re-excision rates as high as 20–70% due to positive resection...

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...

An initial experience with laser haemorrhoidoplasty in addition to mucopexy for symptomatic haemorrhoids

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

Mesothelial Splenic Cyst—A Case Report

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

A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia

Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Abdominal Surgery in Human Immunodeficiency Virus (HIV) Infected Patients—Early Local Experience

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

Adjuvant Chemotherapy for Patients with Resected Dukes’ C and High-risk B2 Colon Cancer with Fluorouracil and Levamisole

Carcinoma of the large bowel is the second leading cause of cancer mortality in Singapore. Although the great majority of patients are discovered at a stage where resection with curative intent is possible, almost half of the patients afflicted will die of it. This article is available only as a...

Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer

Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is available. Physicians then face the difficult task of informing patients that, although palliation is always possible, cure is not. This article is available only as a...

Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia

The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively. This article is...

The Polarprobe—Emerging Technology for Cervical Cancer Screening

Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over fifty years and the test has the advantage of fast and relatively easy sample collection. This article is available only as a PDF. Please click on...

Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Occult Virilizing Ovarian Tumours in Postmenopausal Women: Problems in Evaluation with Reference to a Case

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Pelvic Spleen Masquerading as an Ovarian Neoplasm

A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular menses and a pelvic mass on an abdominal ultrasound arranged by her General Practitioner (GP). She was otherwise asymptomatic. This article is available only as a...

A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer

To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Optimal Treatment in Gestational Trophoblastic Disease

Gestational trophoblastic diseases (GTD) encompass a spectrum of interrelated conditions: Hydatidiform mole (HM) Invasive mole (IM) Choriocarcinoma (CC) Placental site trophoblastic tumour (PSTT) This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Fallopian Tube Carcinoma—A Review

Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Current Management of Early Vulvar Cancer

Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease. This article is available only as a PDF....

Topoisomerase-I Inhibitors in Gynaecologic Tumours

Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been identified: the class I topoisomerases, named “I” because they induce single-strand breaks and reunions of the DNA double helix, and the class II topoisomerases, named...

Screening for Ovarian Cancer

Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the United States. Four thousand women die each year of ovarian cancer in England and Wales, and 13 000 die in the USA. This article is available...

Biomarkers in Carcinoma of the Cervix: Emphasis on Tissue-related Factors and Their Potential Prognostic Factors

Accurate staging is of utmost importance in determining the prognosis of carcinoma of the cervix. Demographic features such as race and socio-economic status have been demonstrated as not having significant influence. This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

The Management Dilemma of the Mildly Abnormal Smear: Fact or Fiction?

Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women even in those countries where organised screening programmes exist. This article is available only as a PDF. Please click on “Download PDF” on top to view...

Adenocarcinoma of the Cervix

It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...

Malignant Ovarian Germ Cell Tumours: Experience in the National University Hospital of Singapore

One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some of the malignant ovarian germ cell tumours had a notoriously bad reputation in terms of aggressiveness and poor prognosis. This article is available only as a...

A Phase II Study of Combined CPT-11 and Mitomycin-C in Platinum Refractory Clear Cell and Mucinous Ovarian Carcinoma

Platinum resistance, either de novo or acquired, is a major obstacle in the treatment of advanced ovarian cancer. Platinum-resistance has been classified into the following three categories; (1) primarily (intrinsically) platinum-resistant disease: tumours showing no change (NC) or progressive disease (PD) while on initial platinum-based chemotherapy; (2) secondarily platinum-resistant...

Single Agent Paclitaxel in Resistant and Relapsed Epithelial Ovarian Cancer After First-line Platinum-based Chemotherapy—Experience in an Asian Population

Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In Singapore, the incidence of this cancer has been rising for the last 25 years. This article is available only as a PDF. Please click on “Download...

Uterine Papillary Serous Carcinoma—The KK Hospital Experience

Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing psammoma bodies. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients

Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control as well as to achieve excellent survival rates. Over the years, however, the specific role and relative benefit of postoperative radiotherapy for this particular cancer...

Outcome of Obstructive Uropathy After Pelvic Irradiation in Patients with Carcinoma of the Uterine Cervix

Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at high risk for local recurrence after radical hysterectomy. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The Surgical Management of Colorectal Complications from Irradiation for Carcinoma of the Cervix

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

Adjuvant Chemotherapy in “High Risk” Patients after Wertheim Hysterectomy—10-year Survivals

Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients in whom preservation of ovarian and coital function cannot be achieved if they were subjected to radiotherapy instead. However, a group of patients undergoing radical...

A Review of Patients with High-risk Carcinoma of the Cervix Treated with Combined Surgery and Postoperative Radiotherapy

It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness with either radical hysterectomy or radical radiotherapy. However a proportion of patients treated with surgery may be classified as having a significant risk of relapse...

Outcome of Early Cervical Carcinoma Treated by Wertheim Hysterectomy with Selective Postoperative Radiotherapy

Cancer of the cervix is the fourth most common cancer in females in Singapore after breast, colorectal and lung cancers. It forms 7.8% of all cancers in females for the period 1988 to 1992. This article is available only as a PDF. Please click on “Download PDF” on top to...

Gynaecologic Oncology—The Next Lap

Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all age groups: rhabdomyosarcoma in young girls, germ cell tumours in teenage girls and young women, cervical cancer in the middle age women, and epithelial ovarian...

Ambulatory Anorectal Surgery—Is it Feasible Locally?

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

Phyllodes Tumour: An Update of 40 Cases

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

The Investigation and Management of Thyroid Nodules—A Retrospective Review of 183 Cases

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

The Role for Preoperative Localisation Techniques in Surgery for Hyperparathyroidism

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

Medicine and Surgery—History, Change and Challenge

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

Haemorrhage into Non-functioning Adrenal Cysts—Report of Two Cases and Review of the Literature

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

Video-assisted Thoracoscopy: Role in the Management of Intrathoracic Pathology

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

Focused Abdominal Sonography for Trauma (FAST)

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

Life-threatening Perineal Gangrene from Rectal Perforation Following Colonic Hydrotherapy: A Case Report

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

Concurrent Chemoradiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma of the Undifferentiated Type

Nasopharyngeal carcinoma (NPC) of the undifferentiated type has a unique geographic distribution and is rather different, biologically and aetiologically, from squamous cell cancer of the head and neck. This disease is of epidemiological concern in Singapore, with an age-standardized rate of 18.4 per 100,000 in Chinese males and 7.3...

Diagnosing and Managing Faecal Incontinence

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

Cancer Gene Therapy—Fantasy or Foresight?

Genes define life, at least in its biological sense. The prospect of being able to manipulate human biological processes through genetic engineering understandably evokes a sense of excitement and omnipotence. Indeed, the birth of recombinant DNA technology in the 1970s immediately opened the floodgates for the successful manipulation of...

A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens

Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been useful in diagnosis and treatment of certain cancers (as tumour markers) and many such antibodies have now been described. This article is available only as a...

3rd Yahya Cohen Lecture: The Role of the Myofibroblast-Like Cell in Hepatocellular Carcinoma—Host Defence?

It is indeed a great honour for me to be named the third Yahya Cohen lecturer and I would like to express my deepest thanks and appreciation to the Academy of Medicine Singapore for having selected me for this award. At this lecture, I would like to share with...

1998 Distinguished Academician Lecture: Hepatic Resection— A Western Perspective

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

1998 Runme Shaw Memorial Lecture: Somatic Evolution of Cancer

The interpretation of cancer as a somatic evolutionary process involving genetic mutation followed by selection, goes back to the early years of this century. Boveri’s hypothesis put forward in 1914 that cancer was associated with abnormalities of the chromosomes and Tyzzer and Strong’s experiments of transplantable tumours in 1916...

Prognostic Factors in Endometrial Carcinoma

In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of 72 per 100,000 women. In Singapore it is the third most common female genital tract cancer after cancer of the cervix and ovary. This article is...

Continuous Infusion 5-fluorouracil as Salvage Chemotherapy in Patients with Advanced Colorectal Cancer

Studies have shown beyond doubt that chemotherapy for metastatic colorectal cancer prolongs survival, impedes progression and stabilises disease. Compared with supportive care alone, it could also provide considerable benefits in terms of improved quality of life. This article is available only as a PDF. Please click on “Download PDF” on...

A Practical Technique of Colour Image Analysis: Applications in Experimental Research

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

Effect of Antiangiogenic Agents on Experimental Animal Models of Hepatocellular Carcinoma

Metastatic spread is the principal reason of treatment failure in solid tumours. Surgery, radiation therapy and chemotherapy have not manifestly altered the prognosis for metastatic tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Immunological Consequences of Trauma and Shock

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

Murine Metastatic Tumour Models for Cancer Gene Therapy Research

In the evaluation of any new cancer treatment, the use of appropriate experimental animal tumour models to bridge the gap between in vitro discovery and its eventual clinical testing is an important step. In vitro experimentation does not take into consideration the complex biological interplay among the host tissues,...

An Animal Model for the Study of Hepatic Stellate Cell and Hepatocellular Carcinoma Interaction

Hepatic stellate cells (HSC) are mesenchymal cells that are prominent in various forms of liver injury, in particular with cirrhosis or carbon tetrachloride-induced fibrosis. HSC are also being increasingly reported around and within hepatocellular cancers (HCC), and have been thought to be responsible for the capsule formation in these...

Synergistic Effect of Hepatitis B Virus and Aflatoxin B1 in Hepatocarcinogenesis in Tree Shrews

Primary hepatocellular carcinoma (HCC) is one of the commonest cancers in some parts of the world including several areas in China. The geographically distinct distribution of HCC indicates there are some special factors which play key roles in hepatocarcinogenesis. This article is available only as a PDF. Please click on...

The Expression of Insulin-like Growth Factor II, Hepatitis B Virus X Antigen and p21 in Experimental Hepatocarcinogenesis in Tree Shrews

Hepatocarcinogenesis is a multistage and multifunctional process. Epidemiological studies indicate that contamination of food with aflatoxin B, (AFB,) and chronic infection with hepatitis B virus (HBV) are the major risk factors for human primary liver cancer. This article is available only as a PDF. Please click on “Download PDF” on...

The Viability of Liver Graft for Transplantation After Prolonged Warm Ischaemia

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

Extended Resection of Locally Advanced (T4) Stomach Cancer

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

Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty: An Audit of the Early Postoperative Results of 100 Consecutive Repairs

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

Design of Phase I and II Clinical Trials in Oncology and Ethical Issues Involved

Drug development is costly and time-consuming in terms of economic, patient and research resources. An integrated effort involving academia, industry, and regulatory authorities is needed to ensure novel, effective therapies continue to be approved for clinical use. This article is available only as a PDF. Please click on “Download PDF”...

Perioperative Deaths: A Further Comparative Review of Coroner’s Autopsies with Particular Reference to the Occurrence of Fatal Iatrogenic Injury

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

Spectrum of Abnormal Mammographic Findings and Their Predictive Value for Malignancy in Singaporean Women from a Population Screening Trial

While screening mammography can detect early breast cancers, a significant proportion of asymptomatic women are subject to unnecessary workup and surgery when biopsies for abnormal mammograms are proven to be benign on histology. An accurate correlation between abnormal mammographic features detected on screening and their corresponding histology or predictive...

Hereditary Breast Cancer: A Brief Overview

Worldwide, breast cancer is the third most common form of cancer, after lung and stomach cancer, and it is the most common form among women.1 The age-adjusted incidence rates of breast cancer are 176% higher in developed than developing countries. This article is available only as a PDF. Please click...

Update of Genetics in Colorectal Carcinomas: Genomic Instability and Somatic Evolution

The hypothesis that carcinogenesis occurs through stepwise accumulation of mutations1 has now been generally accepted. However, there is continual dispute over how carcinogenesis can be achieved over the lifetime of an individual. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Microdochectomy for Single-duct Nipple Discharge

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

Perioperative and Rehabilitative Outcomes after Amputation for Ischaemic Leg Gangrene

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

Adverse Operative Risk Factors for Perforated Peptic Ulcer

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

10th Chapter of Surgeons’ Lecture: The Challenges in Surgery—Past, Present and Future, and in Search of the 4Cs

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

Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report

Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of anticancer activity has been demonstrated. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report

Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000 in females. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Results of Surgical Resection of Oesophageal Carcinoma in Singapore

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

Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding

Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in incidence of 3.68%. It comprises 22.8% of all local female cancers, with an annual mortality of 13.7 per 100,000 per year. This article is available only...

Two Cases of Medullary Thyroid Carcinoma

A 44-year-old Indian man was found to have a raised carcinoembryonic antigen (CEA) (49.5 μg/L) detected on routine medical examination in February 2000. His past medical history included asthma, chronic anal fissure and haemorrhoids, cervical spondylosis and mild hypercholesterolaemia. This article is available only as a PDF. Please click...

Case Report: Follicular Adenoma in a Thyroglossal Duct Remnant Arising Entirely within the Hyoid Bone

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

Digital Hand-held Sonography Utilised for the Focused Assessment with Sonography for Trauma: A Pilot Study

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

The Alvarado Score and Acute Appendicitis

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

Intra-abdominal Hypertension—Implications for the Intensive Care Physician

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

Perioperative Treatment with Bactericidal/Permeability-Increasing Protein (rBPI21) in Major Liver Surgery: A Concise Summary

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

Mucinous Cystadenoma of the Appendix—An Unusual Cause of Intestinal Obstruction

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

Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series

Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

A Case of Alpha-Fetoprotein-Producing Gastric Cancer

A 57-year-old accountant presented to her doctors in a neighbouring country in early October 1998 with problems of easy bruising, bleeding gums, one single episode of gross haematuria and 2 months of back pain. Investigations showed evidence of disseminated intravascular coagulation (DIVC) and compression fracture of T10 vertebra. This article...

Case Report: Acute Tumour Lysis Syndrome

Acute tumour lysis syndrome (ATLS) is one of the most urgent of all oncological treatment-related complications. It has a broad impact on organ dysfunction, the most important and life threatening complication being acute renal failure. Early implementation of preventive measures can have a drastic impact on reducing the associated...

A Prospective Evaluation of Surgeon Performed Sonography as a Screening Test in Blunt Abdominal Trauma

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

Stapled Haemorrhoidectomy—The Evidence For and the Facts Against

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

12th Chapter of Surgeons Lecture: Shifting Paradigms in the Management of Breast Cancer—A Surgical Perspective

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

Double Omental Hernia—Case Report on a Very Rare Cause of Intestinal Obstruction

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

CerbB2 Status in Breast Cancer: Pathologic Issues

The cerbB2 gene, also known as Her2/neu, encodes a transmembrane cell receptor with tyrosine kinase activity and epidermal growth factor receptor homology. All normal and the majority of breast cancer cells contain 2 copies of the cerbB2 gene and produce low levels of the corresponding protein. This article is available...

Cancer Incidence in Singapore, 1998 to 1999

The Singapore Cancer Registry has been monitoring the trends in cancer incidence since 1968. It publishes 5-yearly incidence figures for the periods 1968-1972, 1973-1977, 1978-1982, 1983-1987, 1988-1992 and 1993-1997. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Efficacy and Tolerability of Irinotecan in Patients with Advanced Colorectal Cancer in Singapore

Colorectal cancer is the second most commonly encountered malignancy in the developed countries; in Singapore, it is the commonest cancer. With early detection, patients can be cured with surgery. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Epidemiology and Treatment of Anogenital Warts in Singapore: A Retrospective Evaluation

Anogenital warts are caused by specific subtypes of the human papillomavirus (HPV), of which serotypes HPV 6 and 11 are the most common. There are 3 types of HPV infection: This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

The Mastectomy Clinical Pathway: What Has It Achieved?

In an era of increasing healthcare cost and scarce resources, the tension between the cost and quality of healthcare demands not only effective but also cost-efficient healthcare systems. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Agreement or Prediction: Asking and Answering the Right Question

In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to the difference, in terms of the concepts as well as the practical usage, between analysing agreement and prediction. This article is available only as a PDF....

Preliminary Experience in Radionuclide Therapy of Hepatocellular Carcinoma Using Hepatic Intra-arterial Radio-conjugates

Hepatocellular carcinoma (HCC) is a common malignancy worldwide. In Singapore, the age-standardised incidence rate is 18.9 per 100,000 per year. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Paediatric Extracranial Germ Cell Tumours: A Retrospective Review

Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Emergency Laparoscopic Surgery—The Changi General Hospital Experience

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

Surgical Management and Outcome of Carotid Body Tumours

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

Re: 188Rhenium-TDD-Lipiodol in Treatment of Inoperable Primary Hepatocellular Carcinoma—A Case Report

Hepatocellular carcinoma (HCC) is a common malignancy that is best treated by surgery. However, in the vast majority, surgery is not possible and alternative treatment options have to be attempted. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Hepatolithiasis —A Case Series

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

Acute Embolic Occlusion of the Superior Mesenteric Artery: A Case Report and Discussion of Management

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

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. This article is available only as a PDF. Please...

Radionuclide Therapy of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is a common malignancy worldwide. It is a major cause of death from cancer in East Asia, especially China, Japan, Korea, Taiwan and Singapore, and sub-Saharan Africa, particularly Zimbabwe, Ethiopia and Mozambique. This article is available only as a PDF. Please click on “Download PDF” on top...

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

Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)

Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese. This article is available only as a PDF. Please...

The Molecular Biology of Peritoneal Carcinomatosis from Gastrointestinal Cancer

The term “peritoneal carcinomatosis” was first used by Sampson in 1931 to describe the intra-abdominal spread of ovarian carcinoma. Although ovarian cancers account for the majority of cases, peritoneal carcinomatosis is also frequently associated with gastrointestinal malignancies. This article is available only as a PDF. Please click on “Download PDF”...

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. This article...

Neoadjuvant Chemotherapy in the Management of Colorectal Metastases: A Review of the Literature

Colorectal cancer accounts for the most number of deaths after lung cancer, both in the West as well as locally in Singapore. Liver is the most common site of metastasis in colorectal cancer; an estimated 15% of patients will present synchronously, whilst approximately 50% will develop hepatic secondaries at...

Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience

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

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. This article is available only as a PDF. Please click...

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. This article is available only as a PDF. Please...

Current Concepts of Tumour Metastasis

Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor prognosis in patients with cancer. Early metastasis concepts were based upon the premise of uninterrupted tumour growth, stepwise spread of tumour cells with the inevitable...

Chemoprevention of Colorectal Cancer – Experimental Approach and Clinical Applications

The age-old adage of “Prevention is Better than Cure” is still very relevant in today’s practice of medicine. Many randomised population trials have already shown that colorectal cancer mortality is reducible through early detection and screening. This article is available only as a PDF. Please click on “Download PDF” on...

Practical Issues in Adjuvant Therapy for Rectal Cancer

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

Flat and Depressed Lesions of the Colon and Rectum: Pathogenesis and Clinical Management

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

Surgical Management of Colorectal Metastases to the Liver

Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer. This article is available only as a PDF. Please click on “Download PDF” on top...

Recent Advances in the Total Management of Colorectal Cancer

Considerable improvements in the survival and outcome of colorectal carcinoma have been made in recent years. These have been the result of advances in investigations, intervention as well as in follow-up management. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Unusual Case of Bowel Infarction with Invasive Aspergillus in an Immunocompromised Patient

The role of neoadjuvant chemotherapy for locally advanced breast cancer has been established and there has been a growing interest in its role in early and operable breast cancer.1 Most neoadjuvant chemotherapeutic regimes contain an anthracycline and are usually combined with cyclophosphamide, with or without 5-fluorouracil. This article is available...

Inflammatory Fibroid Polyp of the Caecum in a Patient with Neurofibromatosis

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

15th Chapter of Surgeons Lecture: Surgeon of the New Millennium – Surgeon, Scientist and Scholar

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

Littoral Cell Angioma of the Spleen

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

The HercepTest and Routine C-erbB2 Immunohistochemistry in Breast Cancer: Any Difference?

The proto-oncogene c-erbB2 (also known as HER2/neu) is located on chromosome 17q21 and encodes a 185-kD transmembrane glycoprotein. It belongs to the human epidermal growth factor receptor (tyrosine kinase receptor) family that plays an important role in the regulation of fundamental processes such as cell growth, survival and differentiation. This...

A Case of Metastatic Squamous Cell Carcinoma of the Hypopharynx Manifesting as Acute Abdomen

T, a 23-year-old female, was previously well until November 2000 when she presented with 1-year history of sore throat associated with neck lumps for 2 months. Clinically, she had left cervical lymphadenopathy measuring 3 cm. This article is available only as a PDF. Please click on “Download PDF” on top...

A Case of Maffucci’s Syndrome With Pleural Effusion: Ten-year Follow-up

A 23-year-old male patient was admitted to Ataturk Chest Disease Hospital with non-productive cough, dyspnoea, chest pain and back pain. These complaints had begun 15 days before he was admitted. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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. This article is available...

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...

Two Case Reports of Metastases from Colon Carcinoma to the Thyroid

Metastases to the thyroid are not as rare as previously believed and have been shown, in autopsy series, to be more common than primary thyroid malignancy. The overall incidence, not surprisingly, varies from 1.25% in unselected patient autopsy series to 24% in autopsy of patients with widespread malignant neoplasms. This...

Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population

Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically diverse populations is important for the understanding of cancer patterns and also to provide clues for aetiologic studies. This article is available only as a PDF....

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...

Detection and Quantification of the Abelson Tyrosine Kinase Domains of the bcr-abl Gene Translocation in Chronic Myeloid Leukaemia Using Genomic Quantitative Real-time Polymerase Chain Reaction

Chronic myeloid leukaemia (CML) is a clonal stem cell malignancy characterised by massive proliferation of mature and immature granulocytes, basophils and spleen cells, but not cells of T cell lineage. The molecular hallmark of CML is the reciprocal translocation between chromosomes 9 and 22, t(9;22), which produces the Philadelphia...

The Feminist Approach in the Decision-making Process for Treatment of Women With Breast Cancer

The ethical theories employed in healthcare today generally assume a modern Western philosophical framework, which is applied to many issues such as abortion, euthanasia, consent for treatment and organ transplantation. The application of this approach to non-Western cultures needs critical examination. This article is available only as a PDF. Please...

Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum

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

Infected Pancreatic Necrosis – An Evaluation of the Timing and Technique of Necrosectomy in a Southeast Asian Population

The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely attributed to advances in supportive therapy, diagnostic radiology and a better understanding of the pathophysiology of necrotising pancreatitis. This article is available only as a PDF....

Complications Relating to Intravenous Buprenorphine Abuse: A Single Institution Case Series

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

Postirradiation Sarcoma of the Sphenoid Bone – A Case Report

Radiation-associated tumours of the temporal and maxillary bone have been reported in patients treated with radiotherapy for nasopharyngeal carcinoma. There was no previously reported case of postirradiation sarcoma of the sphenoid bone after radiation therapy for nasopharyngeal carcinoma. This article is available only as a PDF. Please click on “Download...

2005 Galloway Memorial Lecture: Breast Phyllodes Tumours – Morphology and Beyond

The clinical behaviour of phyllodes tumours (PTs) of the breast is difficult to predict.1-5 While histological features have been traditionally used as predictors of clinical outcome, specific parameters that define recurrent likelihood are still not universally agreed upon.2 Though grade,6,7 stromal overgrowth,8,9 tumour necrosis and heterologous stromal elements,10 or...

Phase II Trial of Gemcitabine and Cisplatin Sequentially Administered in Asian Patients With Unresectable or Metastatic Non-small Cell Lung Cancer

Lung cancer is the most common cause of cancer-related death worldwide. It ranks first among males and third among females in the incidence of cancers in Singapore. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

False Positive F-18 Fluorodeoxyglucose Combined PET/CT Scans from Suture Granuloma and Chronic Inflammation: Report of Two Cases and Review of Literature

Postoperative surveillance for recurrence after curative colorectal cancer surgery has been enhanced with the use of F-18 fluorodeoxyglucose (FDG) combined positron emission tomography (PET)/computed tomography (CT) imaging that detect metabolic anomalies via differences in tissue glucose uptake and thus metabolic activity.1-3 This may occasionally pose a problem in distinguishing...

Parathyroid Carcinoma: A Case Series

Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis, such as bone disease, renal disease, or hypercalcaemic crisis, in contrast to the relatively asymptomatic presentation of benign parathyroid disease.2 Problems encountered include difficulty in...

Implementation and Evaluation by Formal Assessments and Term End Student Feedback of a New Methodology of Clinical Teaching in Surgery in Small Group Sessions

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

Putting Together Lesions in the Brain, Retina, Kidney and Pancreas

A 40-year-old Malay lady presented with a 6-month history of headache. She had a past history of a left nephrectomy 6 years ago. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Successful Management of an Iatrogenically-ingested Sharp Foreign Body

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

Assessment of Medical Graduates Competencies

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

Tuberculosis Masquerading as Recurrent Metastatic Carcinoma of the Cervix

The incidences of certain malignancies are increasing and are major causes of mortality. Diagnosis can be difficult and delayed. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Association of Epstein-Barr Virus with Nasopharyngeal Carcinoma and Current Status of Development of Cancer-derived Cell Lines

Although nasopharyngeal carcinoma (NPC) has been reported in almost all parts of the world, most cases of NPC are found in South East Asia, Southern China (including Hong Kong), North Africa and in the Eskimo population of Alaska, USA. For reasons that still remain unclear, the Chinese are more...

Massive Retroperitoneal Adrenal Haemorrhage as the First Manifestation of a Lung Cancer

A 74-year-old man was admitted with sudden onset of right upper quadrant abdominal pain radiating towards right shoulder and right thigh. Pain was aggravated by deep breathing and movements. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

4th FY Khoo Memorial Lecture 2008: Nasopharyngeal Cancer Workgroup – The Past, The Present and The Future

Thank you Madam Chairman. First, I would like to thank the Singapore Radiological Society and the College of Radiologists, Academy of Medicine Singapore for giving me the honor of delivering this the 4th FY Khoo Memorial Lecture, 2008. This article is available only as a PDF. Please click on “Download...

Phase II Trial of Gemcitabine in Combination with Cisplatin in Inoperable or Advanced Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) has a high incidence rate in Asia. In Singapore, it is the third most common cancer amongst males, and constituted 8% of all cancers diagnosed between 1998 and 2002. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Pancreas-only Metastasis from Nasopharyngeal Carcinoma

A 51-year-old Chinese man presented with a 3 month’s history of left cervical lymphadenopathy, rhinorrhoea, tinnitus and nasal congestion. On nasopharyngoscopy, a fungating mass was found in his nasopharynx and was biopsied. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience

Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Advanced Burkitt’s Lymphoma Presenting With Jejunal Perforation

Burkitt’s lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin’s lymphomas. It is predominantly seen in children but may also present in adults. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Successful Surgical Treatment of Renal Cell Carcinoma With Calvarial Metastases

Renal cell cancer (RCC) accounts for 3% of all cancers. Isolated haematuria or pain is the most common form of presentation. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Angioplasty in Critical Limb Ischaemia: One-year Limb Salvage Results

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

The Toxicity and Outcomes of Continuous 5-fluorouracil/Cisplatin-based Chemotherapy Followed by Chemoradiation in Patients with Resected High-risk Gastric Cancer: Results of a Single Institute

Gastric carcinoma is the second most common cause of cancer mortality worldwide. Surgery is the only curative therapy, although 5-year survival rates remain poor even after curative resection. This article is available only as a PDF. Please click on “Download PDF” on top to view the full 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. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

MMP-2, TIMP-2 and CD44v6 Expression in Non-small-cell Lung Carcinomas

Studies have provided data that matrix metalloproteinases (MMPs) facilitate tumour invasion, the establishment of metastases. On the other hand, matrix metalloproteinase inhibitors have been shown to inhibit tumour growth and dissemination in non-small-cell lung carcinomas (NSCLCs). This article is available only as a PDF. Please click on “Download PDF” on...

Salvage Chemotherapy in Progressive High-grade Astrocytoma

High-grade astrocytoma includes glioblastoma multiforme (GBM) (World Health Organization grade 4) and anaplastic astrocytoma (AA) (WHO grade 3). These are the more common gliomas in adults.1 Treatment of these highly aggressive neoplasms remains a challenge. The infiltrative nature of astrocytoma or location of tumour in the eloquent brain precludes...

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore

As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be observed.1,2 This approach allows risk stratification that can reduce the rate of benign lesion removal by diagnostic lobectomies3 and its associated postoperative morbidity.4 However, thyroid...

Multimodal prehabilitation before major abdominal surgery: A retrospective study

Ageing is one of the biggest public health concerns of the 21st century, presenting a challenge to the practice of medicine globally. As the Singapore population ages, research is needed to refine our knowledge in the care of older persons and the frail, so that better methods of care...

Characteristics of unplanned hospitalisations among cancer patients in Singapore

Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the rise and accounts for nearly 30% of total population mortality.4,5 Singapore data suggests that cancer patients accounted for 13% of total healthcare costs in 2016,...

The case for better hospitalisation selection in cancer patients

Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been a significant strain on public healthcare systems to balance the demands of the pandemic and usual medical care. There is little literature detailing emergency department (ED)...

Outcomes of Oral Tongue Cancer: Does Age Matter?

Oral cancer (including oral cavity and oropharynx) is the eighth most common cancer worldwide with oral cavity cancer among the 3 most common malignancies in south central Asia. Oral cavity cancer, including oral tongue, is associated with a relatively high mortality rate particularly in the developing countries. This article is...

Hepatocellular Carcinoma Peritoneal Metastases: Report of Three Cases and Collective Review of the Literature

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

Colorectal Cancer Liver Metastases – Understanding the Differences in the Management of Synchronous and Metachronous Disease

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

Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases

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;...

Coexistence of Unicentric Castleman’s Disease and Locally Advanced Papillary Renal Cell Carcinoma: More Than a Coincidental Association?

Castleman’s disease (CD) is an enigmatic lymphoproliferative disorder due to its rarity, uncertain aetiopathogenesis and heterogeneous clinicopathologic forms. This case report presents an unusual case of concomitant hyaline-vascular type CD of unicentric retroperitoneal localisation and stage IV (T2N2M0) papillary renal cell carcinoma (RCC). This article is available only as a...

Management of Thrombotic Thrombocytopenic Purpura in Metastatic Prostate Cancer with only Endocrine Therapy

Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that presents acutely with multiple organ failure. Although defined classically as a syndrome with a pentad of features, it is accepted now that a diagnosis can be made with the dyad of microangiopathic haemolytic anaemia and thrombocytopenia. This article is available only...

Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer related mortality worldwide with an estimated 34,290 deaths recorded in the United States in 2008. Of these, pancreatic ductal adenocarcinoma (PDAC) accounts for ~90% of all cases. This article is available only as a PDF. Please click on “Download PDF” on...

Emergency Surgery for a Ruptured Intra-abdominal Desmoid Tumour

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

Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore

Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A study analysing pooled FN data from 115 US academic medical centres between 1995 and 2000 showed that the overall in-hospital mortality was 9.5%, whereas pooled...

An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution

Thyroid lesions constitute a considerable bulk of surgical practice, majority of which are thyroid nodules. A large population study revealed that clinically apparent thyroid nodules were present in 6.4% of women and 1.5% of men. This article is available only as a PDF. Please click on “Download PDF” on top...

Complementary and Alternative Medicine among Singapore Cancer Patients

Worldwide, the use of Complementary and Alternative Medicine (CAM) by cancer patients is highly prevalent. For cancer specialists, knowledge on CAM use in their patients is particularly important as there can be potentially hazardous drug interactions between some forms of oral CAM and chemotherapy or radiotherapy. This article is available...

rTSβ as a Novel 5-fluorouracil Resistance Marker of Colorectal Cancer: A Preliminary Study

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...

Dilemmas in Management of Brain Tumours in Pregnancy

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...

Peritoneal-based Malignancies and Their Treatment

Peritonectomy or cytoreductive surgery has been described as the treatment of choice for selected patients with evidence of peritoneal carcinomatosis (PC) from the gastrointestinal tract, peritoneum, ovaries and the disease of pseudomyxoma peritonei. Median survivals in a carefully selected patient population have been shown to exceed that of systemic...

Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China

Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and lymphoid tissues, and is composed of different genetic, biological, and clinically relevant subtypes. Morphological and cytochemical methods were the main tools for diagnosis and classification...

Lower limb nodules

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

A pedunculated mass of the thigh

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

Managing buccal space tumours

Dear Editor, The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are rare and hence present a management challenge. In a recent systematic review of 217 patients, 4 main surgical approaches were identified (intraoral, extended parotidectomy/rhytidectomy, transcutaneous...

Acute Marjolin’s Ulcer: A Forgotten Entity

Marjolin’s ulcers are malignancies that arise from areas of chronic irritation or injury that undergo malignant transformation after a period of many years. Such lesions are predominantly squamous cell carcinomas (SCC) and have long been associated with burn scars. Here we describe an unusual case of Marjolin’s ulcer that...

Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan

Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer was the highest in France (16.1 per 100,000 man-years) and the lowest in India (0.9 per 100,000 woman-years) during 1988 to 1992. A trend analysis in...

A 22-year-old Woman Had a Lung Mass

A 22-year-old woman had an abnormal chest X-ray (Fig. 1) in her regular health examination. She was asymptomatic and a non-smoker. Chest computed tomography (CT) revealed a 4-cm soft tissue mass with internal calcification (Fig. 2A) and enhancement in the left lower lobe (Fig. 2B). The patient received left...

Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma

Dear Editor, Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised but rare ocular manifestation of multiple myeloma. We present a rare case of IgG-lambda multiple myeloma that manifested as polychromatic crystals in the cornea—a presentation...

200 years of surgery at the General Hospital, Singapore

Western medicine in Singapore began with Sir Stamford Raffles’ arrival on 28 January 1819 with a sub-assistant surgeon, Dr Thomas Prendergast, providing medical care for the expedition.1 The first official surgeon, Dr William Montgomerie, arrived in May that year with the 2nd Battalion, 20th Regiment, Bengal Native Infantry and...

Low-Grade Fibromyxoid Sarcoma of the Thyroid: A Case Report

Dear Editor, Low-grade fibromyxoid sarcoma (LGFMS) is a rare form of neoplasm that usually occurs in the deep soft tissue of the lower limbs with a tendency towards local recurrence and distant metastasis. LGFMS affects mainly the young and middle-aged, with both gender having an equal chance of being affected. To...

Five Patients with Medullary Thyroid Carcinoma Presenting as Asymptomatic Elevation of Carcinoembryonic Antigen Level

Early detection of malignancies is not easy. Few methods of health screening have been proven to be of value. The use of carcinoembryonic antigen (CEA) in health screening has never been proven to result in early detection of cancers but requests to test tumour markers continue to be made....

Too Much Medicine: Time to Stop Indiscriminate Cancer Screening

Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in Singapore today is as a result of cancer. It is therefore unsurprising that cancer screening has become an integral part of health screening in primary...

Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes

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

Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

Over the past few decades, the introduction of laparoscopic surgery has been the biggest game changer in abdominal surgery.1 However, although the first laparoscopic liver resections (LLR) were reported in the early 1990s,2,3 widespread adoption of LLR was met with initial skepticism due to technical concerns and the fear...

Laparoscopic liver resection: Global diffusion and learning curve

Laparoscopic liver resection (LLR) is being utilised with increasing frequency worldwide, as initial concerns about the safety and feasibility of LLR, such as the risk of uncontrolled major haemorrhage and potential compromise of oncologic outcomes, were not supported by the data. On the contrary, LLR was found to be...

Prehabilitation and Its Role in Geriatric Surgery

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

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...

Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy

Oesophageal cancer is the 7th most common cancer in the world, with 572,034 new cases diagnosed in 2018, and is the 6th most common cause of cancer-related mortality worldwide. Oesophageal squamous cell carcinoma (SCC) is the predominant histological subtype. However, the incidence of adenocarcinoma has risen among the Western...

Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen

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

Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians

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

Transcatheter Aortic Valve Implantation in Singapore: Reflecting on the First Decade

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

Penile preserving surgery in penile cancer management

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

Circulatory collapse from rupture of splenic artery aneurysm: A case study

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