A 77-year-old Chinese woman with a past medical history of Sjogren’s syndrome, nodular goitre and right-sided neck lymphadenopathy, presented to the gynaecological service for...

Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is...

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....

Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over...

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...

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...

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...

Urogenital fistulas are a known but uncommon complication of gynaecological surgery, especially those involving a malignant process. Its incidence does not exceed 2%.This article...

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...

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...

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...

Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although...

Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been...

Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the...

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...

Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women...

It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the...

One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some...

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...

Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In...

Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing...

Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control...

Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at...

Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma...

Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients...

It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness...

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...

Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all...

Postmenopausal osteoporosis is the most common cause of osteoporosis. It is heralded by the cessation of oestrogen production by the ovaries resulting in at...

Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various...

Diabetic retinopathy is the leading cause of blindness in persons between the age of 24 and 64 years both in the US and the...

Cervical intraepithelial neoplasia (CIN) is a neoplastic disorder in which infection with sub-types of the human papillomavirus appears to play an important aetiological ro1e....

The most common chromosomal abnormalities in newborns are trisomy 21, trisomy 18, trisomy 13, and monosomy X, with incidences of 1/800, 1/8,000, 1/20,000, and...

Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been...

In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of...

The first pregnancy resulting from the thaw and transfer of cryopreserved pre-embryos was reported in 1983 by Trounson and his team, in Melbourne, Australia....

Increase in the plasma lipid fractions in normal pregnancy have been described but irregularity of sampling, difference in materials studied (whole blood, serum, and...

A 55-year-old Chinese lady had a left mastectomy in April 1995 for an invasive lobular carcinoma of the breast. Axillary lymph node metastases were...

Evaluating new drugs for marketing approval is a highly specialised and knowledge-intensive activity. This is especially so if the intention is to conduct quality,...

Three to four per cent of men have severe defects in sperm production that result in infertility. Most of these men are healthy and...

Association and agreement between two factors are very different concepts, although the methods used to describe them appear similar. For example, the association between...

Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of...

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...

Many areas of medical research require the application of statistical techniques. Although most clinicians are taught some statistics as part of their basic medical...

Occupational asthma is the most common occupational respiratory disease in the United Kingdom and also in Singapore. Recent estimates of the proportion of adult...

The traditional statistical approach used in most areas of medical research involves what is commonly known as frequentist statistics. Bayesian methods provide an increasingly...

Helicobacter pylori is one of the commonest infections in human, affecting 30% to 50% of people worldwide. It is associated with the development of...

Since the onset of the acquired immunodeficiency syndrome (AIDS) epidemic in the mid-1980s, the number of HIV-infected cases has risen sharply throughout the world....

The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it...

Pregnancy is associated with physiological changes in various organ systems and complications arising from the interaction between these changes and disease processes may be...

Type 2 diabetes mellitus is now recognised as a metabolic syndrome and although the treatment paradigm has shifted from one that focuses solely on...

Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders...

Osteoporosis is an important cause of fractures in the elderly. In the USA alone, at least 1.3 million fractures are attributed to osteoporosis a...

In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to...

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness in the developed western world, accounting for approximately 50% of all cases of...

Cervical cancer is one of the most common female cancers worldwide. It is ranked second only to breast cancer and in many underdeveloped countries,...

Essential thrombocythaemia (ET) is a rare myeloproliferative disease which manifests with an elevated platelet count. It presents predominantly in the middle-aged population, occurring slightly...

The nail-patella syndrome (NPS) is a rare autosomal dominant disorder defined by the association of nail dysplasia, bone abnormalities and, frequently, renal disease. We...

Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis...

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1...

A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there...

Pre-eclampsia is a major cause of adverse obstetric outcome. It remains one of the leading causes of maternal mortality1 and continues to contribute significantly...

Venous thromboembolism (VTE) refers specifically to 2 related entities: deep vein thrombosis (DVT) and pulmonary embolism. The management of arterial thrombo-embolism, in particular that...

Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The...

Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred...

Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more...

Successful renal transplantation significantly improves the sexual and reproductive functions of women with end-stage renal disease and offers the best hope for those who...

The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998....

Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated...

It is said that, worldwide, over half a million maternal deaths occur annually. This might well be a conservative estimate, given the difficulties inherent...

Nowhere is the fate of two individuals more closely intertwined than that of the mother and her fetus. Pregnancy is a unique state where...

Maintaining a patent upper airway is the first principle in resuscitation and acute care. This is usually carried out by anaesthesiologists, emergency medicine physicians...

Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It...

Osteoporosis is a major public health problem causing considerable morbidity and mortality in Asian women. It is estimated that half of the world’s hip...

Bronchopulmonary dysplasia (BPD) and chronic lung disease of infancy (CLD) are two chronic pulmonary conditions which are the result of incomplete resolution or abnormal...

Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A...

Bone fragility in men has been receiving greater attention during the last few years. Epidemiological studies have been done in Caucasian and Asian populations.This...

Corticosteroids are known to affect bone through multiple pathways (Fig. 1), influencing both bone formation and bone resorption, and these mechanisms have been reviewed....

Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of...

An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult...

Singapore is facing a rapidly ageing population. Osteoporosis, which is an age-related illness, will become an increasing problem. Osteoporotic hip fracture, because of the...

Genuine stress incontinence (GSI) is the most common cause of female urinary incontinence. When conservative treatment fails, surgery is indicated. Open Burch colposuspension is...

Endometrial cancer is the most common female genital malignancy in industralised countries today. Despite the overall favourable prognosis in this neoplasia, survival is associated...

Important prognostic factors in stage 1B cervical carcinoma include primary tumour diameter, nodal metastases, depth of stromal invasion, lymph-vascular invasion, microscopic parametrial extension and...

Epithelial ovarian cancer is the leading cause of death in patients with gynaecological malignancies in Singapore and developed countries, the main reason being the...

Arteriovenous malformations (AVMs) of the uterus are rare but potentially life-threatening lesions. The common presentation is vaginal bleeding and, if not diagnosed correctly, can...

Although the presence of fetal echogenic bowel (EB) has been largely regarded as benign, it has been viewed as a soft marker for various...

Umbilical cord prolapse is an uncommon intrapartum event with a reported incidence of 1 in 160 to 714 deliveries. Predisposing factors include fetal malpresentation,...

The National Health Service (NHS) was established in the United Kingdom (UK) in 1948, against a post-war background of poverty and ill health. The...

Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in...

Infertility is defined as the inability to conceive after 1 to 2 years of unprotected intercourse. In general, an estimated 84% of all women...

The understanding of hormone replacement therapy (HRT) for postmenopausal women has undergone dramatic change since the publication of the results of the Women’s Health...

Without prenatal diagnosis, 1 in 50 babies are born with serious physical or mental handicap, and as many as 1 in 30 with some...

Cervical cancer affects >400,000 women a year worldwide, and represents a significant health issue for women. In the United States (US) however, screening programmes...

A chromosome abnormality contributes significantly to fetal loss during pregnancy, and perinatal morbidity and mortality. The contribution of chromosomal abnormalities to fetal loss decreases...

Caesarean sections performed without medical indication, better known as maternal request caesarean sections, have generated intense debate in recent times. While uncommon in the...

The science and art of providing quality health care to women has made tremendous strides in recent years. In the subspecialties of Obstetrics and...

Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety...

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...

The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.This article...

Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality....

Increasing rates of caesarean deliveries have received widespread attention in recent years and has increased widespread discussion in the public domain. The ideal caesarean...

Obstetric cholestasis (OC) is a pregnancy-specific liver disorder. It is also known by other names, such as pruritus gravidarum, recurrent intrahepatic cholestasis of pregnancy...

Technology in sonography has advanced tremendously in recent years, contributing to improvements in clinical applications for prenatal diagnosis and fetal therapy. These include transvaginal...

Birth weight remains one of the most important measures we have of the health status of a population, being a strong predictor of both...

Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver...

Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in...

Since the acquired immunodeficiency syndrome (AIDS) was first diagnosed in Singapore in 1985, its incidence rose from 15 cases in 1988 to 226 in...

Dear Editor,Labour analgesia provided through the central neuraxial approach is offered for parturients who are in their active stage of labour, usually after 2–4cm...

The diagnosis of preterm labour poses a problem. Preterm labour accounts for about 50% of preterm births; however, most data reveal that only about...

Has it done any good to pregnancy outcome as promised?This article is available only as a PDF. Please click on “Download PDF” on top...

Optimal chromosome preparation is a function of many factors. These include cell density culture initiation, optimal time for harvest, concentration and exposure duration to...

Although no significant survival difference exists between primary surgery and radiotherapy (RT) for the treatment of FIGO stage Ib cervical cancer, radical surgery is...

Uterine leiomyomas are the most common gynaecological tumour. Typical appearances of leiomyomas are easily recognised on imaging.This article is available only as a PDF....

Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include...

The diagnostic work-up of abnormal liver function tests (LFT) in pregnancy is challenging, as the conditions peculiar to pregnancy have to be considered in...

Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The...

The rates of myopia, including high myopia , have been reported to be rising to epidemic proportions in Asia and solutions to this huge...

Using the Baden-Walker halfway system, Grade 4 cystoceles are defined as extrusions of the bladder base beyond the vaginal introitus with patient straining maximally...

This handbook is written by 3 obstetricians and gynaecologists based at the KK Women’s & Children’s Hospital, Singapore. It is an excellent book that...

The incidence of non-immune hydrops (NIH) has been reported to be 1/10001 and is associated with high perinatal morbidity and mortality at all gestational...

Quantitative ultrasound (QUS) systems measuring the calcaneus are currently approved for the assessment of osteoporotic risks in Europe, Canada and the USA. A QUS...

Atrial isomerism is a disorder of lateralisation characterised by symmetric development of normally asymmetric cardiac atria and organ systems. The synonyms for these defects...

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...

Chylous ascites is an unusual phenomenon where there is accumulation of chyle in the peritoneal cavity. It is especially rare following treatment of gynaecological...

Pseudoxanthoma elasticum (PXE) is an inherited multisystem disorder of the elastic tissue leading to skin disease as well as ocular and cardiovascular complications. Although...

Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate...

Osteoporosis is a condition in which an increased risk of fracture takes place due to a reduction of bone mineral content. It occurs as...

Laparoscopy was first used for the evaluation of acute abdominal pain in pregnancy by gynaecologists in 1980. The most commonly reported laparoscopic procedure during...

Laparoscopic sterilisation is a common method of permanent contraception. The Filshie clip system is a safe and effective method of female sterilisation.This article is...

Menopause is a life change described by biological alterations occurring in the context of important social changes. There is an increasing appreciation for the...

Endometriosis commonly affects women during their reproductive years and may involve any organ. Although rare, endometriosis has been reported in postmenopausal women and is...

Cardiovascular disease is a major cause of morbidity among postmenopausal women. Up to the age of 50 years, the prevalence of coronary artery disease...

Human milk is the ideal food which provides the complete nutritional requirements for infants during the first 6 months of life. The lipids accumulated...

Smooth Muscle Tumours of Undetermined Malignant Potential or STUMPs are interesting tumours from both the standpoint of histological diagnosis and classification as well as...

Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases...

The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to...

The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health...

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...

Studies of monozygotic and dizygotic twins represent an important approach in estimating the relative contributions of genes and environment to the development of various...

Intermittent auscultation (IA), cardiotocography (CTG), amniotic fluid colour and fetal scalp capillary blood gas analysis are currently accepted standards for intrapartum fetal monitoring. According...

Different contraceptive options are available today; however, tubal sterilisation is still one of the most prevailing contraceptive alternatives. Locally, many prefer mechanically occluding the...

Dual energy X-ray absorptiometry (DEXA) is currently the gold standard for the assessment of bone mineral density (BMD). It is the commonest tool used...

Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms...

The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The...

It is very likely that in 10 years time, invasive prenatal diagnostic tests like amniocentesis and chorionic villus sampling (CVS) will join the club...

Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either...

A shift in worldwide population ageing demographics has occurred in the 21st century. The longevity miracle is most keenly felt in Singapore, a young...

Obesity during pregnancy is associated with increased risk of adverse health outcomes such as gestational diabetes mellitus (GDM), hypertension and preeclampsia. Unlike the well-known...

Uterine rupture is a catastrophic life-threatening complication of pregnancy with associated high maternal and neonatal morbidity and mortality. The incidence of uterine rupture varies...

Uterine rupture is arguably one of the most dreaded acute obstetric complications in obstetrics. Synonymous with significant maternal and perinatal morbidity and mortality risks,...

Cervical cancer is the most common gynaecological cancer in many countries in Southeast Asia, with a cumulative age-standardised incidence rate (ASRI) of 17.2 per...