Letter to the Editor
Cone beam CT for paranasal sinus and temporal bone: A cost-benefit analysis in Singapore
Dear Editor,
Cone beam computed tomography (CBCT) has emerged as a valuable imaging tool in Otorhinolaryngology or the specialty of ear, nose and throat (ENT), where precise imaging of the sinus and temporal bone pathologies is essential. This paper presents a cost-benefit analysis (CBA) of CBCT in a public healthcare...
Letter to the Editor
Automated Cobb angle measurement in scoliosis radiographs: A deep learning approach for screening
Dear Editor,
Adolescent idiopathic scoliosis is the most common paediatric spinal deformity, impacting 1 in 300 children.1 In Singapore and other countries, national screening programmes have been established to detect scoliosis early, with the aim of using bracing to prevent progression to moderate or severe scoliosis, which may require surgical...
Letter to the Editor
The emergence of otter attacks in Singapore: A case series and strategies for management
Dear Editor,
Singapore is experiencing an unprecedented increase in the number of smooth-coated otters (Lutrogale perspicillata). Since 2017, the local otter population has more than doubled to at least 170. This has led to an increase in the number of otter-human attacks since 2021.1,2 While common animal attacks like dog...
Original Article
Clinical utility of PET/MRI in multiple myeloma
Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Letter to the Editor
Managing and preventing severe hand injuries among sugarcane juicer operators
Dear Editor,
Of all hand injuries encountered at an emergency department, 54% are sustained in the workplace,1 in part contributed by occupational injuries among food and beverage operators that caused a loss of 16,197 man-hours in 2021 alone.2 Commonplace in Singapore and in parts of South and Southeast Asia is...
Original Article
Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging
Allergic and non-allergic hypersensitivity reactions to iodinated contrast media (ICM) are increasingly recognised, particularly the latter where there is greater clarity on pathomechanisms.1 There is limited evidence for the use of corticosteroids as premedication to prevent the occurrence of contrast-related reactions. At our institution, a dose of 30mg oral...
Editorial
Preventing recurrent hypersensitivity reactions to iodinated contrast media
Iodinated contrast media (ICM) is one of the most commonly used drugs in the practice of modern medicine. ICM, as the name implies, is a contrast media that contains iodine. It is frequently used in computed tomography (CT) and angiographic procedures, to highlight important anatomical structures and for the...
Letter to the Editor
Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations
Dear Editor,
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations. It can involve single or multiple organs, and presentations range from asymptomatic lesions detected incidentally on imaging to severe organ dysfunction. Hence, accurate and timely...
Commentary
Low-dose computerised tomography screening for lung cancer in Singapore: Practical challenges of identifying participants
INTRODUCTION
In March 2022, the European Commission on cancer screening suggested the inclusion of low-dose computerised tomography (LDCT) for lung cancer, targeted at current and former smokers.1 The aim of LDCT screening is to increase early detection, decrease diagnoses at metastatic stage of the disease and improve overall 5-year...
Images in Medicine
TB or not TB? The axillary lump question
An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...
Letter to the Editor
Safe time interval for screening estimated glomerular filtration rate prior to gadolinium-enhanced MRI scan
Dear Editor,
Magnetic resonance imaging (MRI) contrast media are commonly used in medical imaging and are usually gadolinium-based contrast agents (GBCAs). They can be divided into 3 groups. Group I consists of compounds with linear molecular structures. Group II consists of compounds with macrocyclic molecular structures. Group III currently includes...
Letter to the Editor
Optimum follow-up period of arthroscopic and mini-open rotator cuff repairs
Dear Editor,
Rotator cuff disorders are the most common cause of disability related to the shoulder,1 and rotator cuff repairs—via mini-open or arthroscopic techniques—are considered in patients with refractory symptoms.2 While there are multiple studies analysing short- and long-term follow-ups, there are no clear consensus regarding the minimum follow-up...
Commentary
The Lancet Commission on diagnostics: What it means for Singapore
Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and global disparity regarding this healthcare value chain has been one of the fundamental problems with prioritised urgency since the United Nation’s Millennium Development Goals were...
Original Article
Reduction in Retake Rates and Radiation Dosage Through Computed Radiography
New computed radiography imaging systems are slowly gaining a foothold in radiological departments worldwide. By computed radiography we mean a digital imaging system which exposes a photostimulable phosphor image receptor plate to obtain a latent image using existing radiographic equipment.
This article is available only as a PDF. Please click...
Original Article
Computed Tomographic and Magnetic Resonance Imaging Findings in Paranasal Sinus Involvement in Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma (NPC) is an aggressive infiltrative neoplasm. Spread into the paranasal sinuses is often seen but the frequency is documented in only a few series.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Anthropometry of Anterior Cruciate Ligament in Singaporean Chinese
Anterior cruciate ligament (ACL) reconstruction is a technically precise and demanding operation. Attention to factors such as the tunnel position, graft selection, fixation and rehabilitation play an important role in determining the final outcome.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
Surgical Results of Open Reduction and Plating of Humeral Shaft Fractures
Management of humeral shaft fractures has been the subject of controversy (Böhler, Ekkernkamp and Muhr, Nast-Kolb and Schweiberer). The problem of non-union, wound infection and most important of all iatrogenic radial nerve palsy led many to favour a conservative approach.
This article is available only as a PDF. Please click...
Original Article
Operative Treatment of Displaced Talar Neck Fractures
Talus is a weight bearing bone with peculiar anatomy and blood supply. It forms the ankle joint with the medial and lateral malleoli, subtalar joint with the calcaneum and talonavicular joint with the navicular bone.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Book Review
This book is a collection of 30 case studies, which were published in the Singapore Medical Journal from 1994 to 1997. They include interesting cases from all the major anatomical regions and organ systems.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Others
A Case Report of Atasoy Antenna Procedure
The hook nail deformity is a relatively common problem after fingertip amputations. It is usually ignored but can be quite disabling.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Bone Mineral Density—Correlation between Quantitative Ultrasound Characteristics and Dual Energy X-ray Absorptiometry
Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various methods for measuring bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) has proven so far to be reasonably precise (about 1% to 2%) and accurate...
Review Article
A Review of the Role of Magnetic Resonance Imaging in the Evaluation of Shoulder Impingement Syndrome and Rotator Cuff Tendon Tears
In the evaluation of chronic shoulder pain and dysfunction clinically suspected to be due to shoulder impingement syndrome and rotator cuff tendon tears, magnetic resonance imaging (MRI) has virtually replaced double contrast shoulder arthrography. MRI has the advantage of demonstrating the shoulder joint in multiple anatomical planes with excellent...
Original Article
Double Level Fractures of the Femur Treated with Closed Intramedullary Nailing
Closed locked intramedullary nailing of the femur has become the accepted means of treating fractures of the femur. The use of locking nails has extended the technique from stable diaphyseal fracture patterns to nearly all fractures of the femur except for fractures at the very end of the bone...
Original Article
Portable Chest Radiography: Comparison of High-resolution Digital Displays with Laser Printed Digital Film
In most institutions, about 10% to 25% of imaging examinations are recorded digitally (e.g. digital subtraction angiography, computed tomography, magnetic resonance imaging and ultrasound). Conventional-projection radiographic studies are still displayed in an analog fashion (on film).
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome
Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with the advent of modern non-invasive imaging techniques, percutaneous techniques performed under imaging guidance have, over the recent years, become increasingly acceptable as a suitable alternative...
Original Article
Contrast-Enhanced Magnetic Resonance Imaging of the Internal Auditory Canals and Posterior Fossa
Contrast-enhanced magnetic resonance imaging (MRI) is now the gold-standard examination for the exclusion of acoustic schwannomas or other posterior fossa tumours. We retrospectively reviewed 314 cases done over a period of 2 years and 9 months, correlating presenting symptoms with scan findings.
This article is available only as a PDF....
Review Article
Imaging of Thoracic Manifestations of Scleroderma
Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys, and heart. The American College of Rheumatology has proposed that for the purpose of clinical trials and surveys, the diagnosis is made if the patient...
Review Article
Overview of Imaging in Rheumatologic Diseases
Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations and advances in technology in imaging and interventional radiology today enable more precise and earlier detection, assessment and treatment.
This article is available only as a...
Others
Osteoid Osteoma after a Stress Fracture of the Tibia: A Case Report
A 24-year-old man complained of left leg pain following 3 months of infantry training 6 years ago. There was no previous complaint of pain over his left leg and there was no trauma.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Others
Reconstruction of a Supinated Hypoplastic Thumb with Combined Huber Transfer and Derotation Osteotomy: A Case Report
A 6-year-old Chinese girl presented with a deformity of the left thumb since birth. Her father has a similar deformity.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Extraarticular Villonodular Synovitis of the Tendoachilles: A Case Report
Pigmented villonodular synovitis is a progressive synovial lesion of uncertain aetiology associated with synovial-lined tissues of the joints, tendon sheaths and bursae. The incidence was 1.8 patients per million population.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Embolisation of a Leaking Pseudoaneurysm of the Main Artery Supplying a Replanted Arm: A Case Report
Pseudoaneurysms are conventionally treated by surgery. In recent years, non-surgical methods are being considered, including embolisation with wires, coils or gelfoam and anticoagulation.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Magnetic Resonance Imaging of Brain Metastases: Magnetisation Transfer or Triple Dose Gadolinium?
Accurate detection of brain metastases is an important part of tumour staging. Magnetic resonance (MR) imaging is well accepted as a sensitive tool in the detection of brain metastases.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Radiological Placement of 211 Central Venous Catheters: Outcome and Complications
Long-term central venous access is an important part of modern medical practice, especially in the haematology and oncology units. Central venous (CV) catheters are used for the administration of anti-neoplastic agents, immunosuppressive drugs, antibiotics, blood components, hyperalimentation, for frequent blood sampling, and for acute and temporary haemodialysis prior to...
Others
Comparison of First Carpometacarpal Joint Arthrodesis with Contralateral Excision Arthroplasty in a Patient with Bilateral Saddle Joint Arthritis: A Case Report
The carpometacarpal joint (CMCJ) of the thumb is commonly afflicted with degenerative arthritis. Of the patients seeking surgical treatment, post-menopausal women outnumber men by a ratio of 15 to 1.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
9th Chapter of Surgeons’ Lecture: The Orthopaedic Surgeon: Historical Perspective, Ethical Considerations and the Future
The legacy of caring and humanitarianism has been the mission of the medical profession since the founding of Singapore by Sir Stamford Raffles in 1819. To this small fishing village in the Riau Archipelago on the southern tip of the Malay Peninsula came traders and entrepreneurs from China, India...
Original Article
A Study of Joint Mobility in a Normal Population
Joint mobility varies between individuals and factors such as age, sex, race and heredity influence the range of motion of a joint. Excessive mobility of a joint(s) or hypermobility is a feature found in normal individuals as well as in patients with connective tissue disorders such as Ehlers-Danlos syndrome,...
Original Article
Delayed Amputation in Lower Limb Trauma: An Analysis of Factors Leading to Delayed Amputation
The decision whether to amputate or to attempt a limb salvage procedure in a mangled extremity is a difficult one. Numerous protocols have been published in the literature to help surgeons in the decision making.
This article is available only as a PDF. Please click on “Download PDF” on top...
Commentary
Tissue Microangiography Using a Simplified Barium Sulphate Cadaver Injection Technique
The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections, combined with injections to outline the blood supply.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Original Article
Establishment of Animal Models Using Experimental Rats for Allogeneic Tissue Transplantation and Quantitative Flow Cytometric Detection of Immunochimera
Allogeneic tissue and organ transplantation has long been an important medical issue, as it provides an effective treatment alternative for a broad spectrum of medical problems. It is essential to establish the animal models used for a specific type of allogeneic tissue or organ transplantation prior to its clinical...
Original Article
Radionuclide Studies of Articular Cartilage in the Early Diagnosis of Arthritis in the Rabbit
Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis of osteoarthritis.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
The Effect of Storage at -70°C and -150°C on the Torsion Properties of the Canine Femur
Allograft transplantation of bone has been established as a viable and useful reconstructive procedure when limb salvage is the option of choice. For bone allografts, this is thought to be due to the relatively avascular structure and that low-freezing or freeze-drying for periods beyond three months reduces cellular immunogenicity.
This...
Original Article
Use of Titanium Prosthesis to Bridge a Vertebral Gap in the Spine—A Preliminary Experimental Study
Bridging a vertebral gap in the spine is one of the commonest problems facing the spine surgeon after dealing with a tumour, infection or a fracture. The gold standard today is still the autogenous graft, though other solutions are the allograft, bone cement fashioned as a block, ceramics and...
Original Article
The Results of Autogenous Tibial Periosteal Transplants for Full Thickness Cartilage Defects in the Knee Joints of Pigs
Articular cartilage injuries to the knee are commonly seen by team doctors, sports physicians and orthopaedic surgeons. Despite many clinical as well as experimental studies on the healing of such defects, the ability to regenerate mature hyaline cartilage capable of withstanding daily functional stresses in the knee remains a...
Others
Retroperitoneal Castleman’s Disease in the Perinephric Space—Imaging Appearance: A Case Report and a Review of the Literature
Castleman’s disease (CD) was first proposed by Castleman in 1954. It is usually found in the mediastinum, but other sites have been described.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Evaluation of Technetium-99m Ciprofloxacin (Infecton) in the Imaging of Infection
Over the past 10 years we have used various radiopharmaceuticals (RPCs) for imaging of inflammation and infection. These include gallium-67 citrate and the technetium-99m labelled nanocolloids, immunoglobulin (IgG), antigranulocyte antibodies (AGAB) and HMPAO-labelled leukocytes.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
Use of Low Molecular Weight Heparin for Prevention of Deep Vein Thrombosis in Total Knee Arthroplasty—A Study of its Efficacy in an Asian Population
The role of thromboprophylaxis in total knee replacement (TKR) remains controversial. In several reports, the incidence of deep vein thrombosis (DVT) has been significant.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Deep Vein Thrombosis after Total Knee Replacement
Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis, its incidence is quoted between 46% and 84% in various studies.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Management of Growth Arrest with Tissue-engineered Cells
Before I go on to the scientific aspects of my talk, I would like to pay tribute to Dr Yahya Cohen. Dr Cohen was born in Singapore of Jewish parents.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Surgical Results of Intercondylar Fractures of the Adult Femur
Fractures of the intercondylar region of the femur often resulted from high velocity accidents. This would lead to increased comminution and involvement of the articular surfaces, making them a complex group of injuries to treat.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
A Case Report of Total Finger Joint Replacement Arthroplasty After Traumatic Amputation
A 41-year-old Chinese man had his dominant thumb, index and middle fingers caught by a wood-cutting machine while at work. He sustained a near-amputation of his middle finger through the proximal interphalangeal joint (PIPJ), with an intra-articular comminuted fracture of the head of the proximal phalanx (Fig. 1a) and...
Others
Re: Rikhraj I S, Tan C T, Tan S K, Teoh S H, Hastings G W. Use of Titanium Prosthesis to Bridge a Vertebral Gap in the Spine–A Preliminary Experimental Study. Ann Acad Med Singapore 1999; 28:20-4
In a recent issue of the Annals, Academy of Medicine, Singapore the above-mentioned paper was published. Figures 6 and 7 of the paper plot the displacement of bovine lumbar motion segments under torsion.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Original Article
Biomechanical Study of C2 (Axis) Fracture: Effect of Restraint
In human, the occipito-atlanto-axial (C0-C1-C2) joint complex is an important region of the spine and often susceptible to impact injury in trauma. Traffic accidents frequently produce a distinct variety of fracture (or fracture-dislocation) of the upper cervical spine, characterised by a bilateral avulsion-fracture through the neural arch of C2...
Original Article
Results of Distal Radial Fractures Treated by Intra-focal Pin Fixation
Unstable fractures of the distal radius remain a challenge to orthopaedic surgeons. Unsatisfactory results are often associated with significant malunion.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
An Introduction to Biodegradable Materials for Tissue Engineering Applications
The concept of tissue engineering arises from the need to develop an alternative method of treating patients suffering from tissue loss or organ failure. Current therapies in use today are not only expensive but often do not adequately fulfil their intended purpose.
This article is available only as a PDF....
Others
Galeazzi-Equivalent Fracture in Children Associated with Tendon Entrapment—Report of Two Cases
A 12-year-old boy fell whilst running. On examination, there was swelling and deformity of the wrist and there was local tenderness of the distal third of the radius and the distal end of the distal ulna. Movement of all the fingers and thumb were limited by pain.
This article is...
Original Article
The Posterior Cruciate Ligament: An Anthropometric Study in Asians and Evaluation of Safe Limits for Bony Tunnel Creation During Reconstruction
The posterior cruciate ligament (PCL) provides the main restraint to posterior translation of the tibia on the femur and is stronger than its anterior counterpart. Indeed, it has been regarded by some authors as the primary stabiliser of the knee.
This article is available only as a PDF. Please click...
Original Article
Advances in Surgical Treatment of Osteoporotic Fractures of the Spine
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 year.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Commentary
The Bone and Joint Decade 2000-2010
With the ageing population, degeneration of joints and osteoporosis and the resultant disability pose big public health problems in many countries of the world. These, together with the more disabling infective and inflammatory diseases of joints and the all-pervasive trauma damage joints in hundreds of millions of people in...
Others
A Deceptive Cervical Lymph Node: A Solitary Spinal Osteochondroma
Osteochondromas are cartilage-capped bony exostoses that arise mainly from the metaphyses of long bones from a lateral displacement of the epiphyseal growth cartilage, but any bone formed by endochondral ossification (bones that develop from cartilage) may give rise to osteochondromas. Osteochondromas may arise in a solitary form or in...
Original Article
Limited Magnetic Resonance Imaging (MRI) and the Occult Hip Fracture
Worldwide, in the past decade, the application of magnetic resonance imaging (MRI) has increased tremendously in the management of musculoskeletal trauma. Not least is its application as a valuable diagnostic tool in occult hip fracture evaluation.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Extremity Osteosarcoma—A Southeast Asian Experience
Osteosarcoma is a highly malignant bone cancer occurring primarily in young patients. Although rare, it is still the commonest primary bone cancer seen in Southeast Asia.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Towards a Splint-free Repair for Flexor Tendon Injuries
The most problematic area in flexor tendon injuries is zone two. This zone is prone to injury as it is in the grasping part of the hand.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Biomechanics of the Shoulder
The shoulder is a complex of 5 articulating surfaces that together form the shoulder girdle. The glenohumeral joint together with the scapulothoracic articulation form the main components of the girdle.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Instrumentation in Spinal Surgery
Spinal instrumentation is defined as the use of mechanical devices that enhance or restore the segmental stability of the spine. Internal fixation of the spine began more than a hundred years ago and initially consisted of wires, and/or rods attached to the spine.
This article is available only as a...
Review Article
The Growth and Development of Orthopaedic Sports Medicine in Singapore
Orthopaedic sports medicine in Singapore took form as a subspecialty of orthopaedic surgery over a number of years. Several individuals contributed to it being set up as an orthopaedic subspecialty.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Paediatric Orthopaedics in Singapore
The name “Orthopaedic Surgery” is derived from the words “orthos” (meaning straight or to straighten) and “paido” (meaning child). Thus, it is not unexpected that paediatric orthopaedics was the first discipline within Orthopaedics to develop as a subspecialty.
This article is available only as a PDF. Please click on “Download...
Others
Addresses at the 50th Anniversary Celebration of the Department of Orthopaedic Surgery, National University of Singapore on 5 April 2002
Over 200 guests were gathered at the Fullerton Hotel Ballroom on the 5th of April 2002 to commemorate the 50th anniversary of the Department of Orthopaedic Surgery, National University of Singapore. The event was dedicated to the teachers, past and present, for their commitment to education.
This article is available...
Others
History of the Singapore Orthopaedic Association
The University of Malaya in Singapore was established in 1949. With this, the King Edward VII College of Medicine became the Faculty of Medicine, University of Malaya.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
History of the Orthopaedic Specialty in Singapore
When the practice of orthopaedic surgery first began in Singapore, it was not a specialty in itself. There are no records as to when the first orthopaedic cases were managed, but it must have been when modern medicine was introduced into Singapore, at the beginning of the twentieth century...
Editorial
50th Anniversary Celebrations—Golden ……. but all is not gold
On an occasion such as this—the 50th anniversary of the inauguration of orthopaedic surgery as a specialty service in Singapore—acclaim, commendations, praise and endorsement of our achievements will be the order of the day. This issue of the Annals carries 13 articles representing the different facets of our achievement.
This...
Original Article
Technetium-99m Methoxyisobutylisonitrile Imaging in the Follow-up of Differentiated Thyroid Carcinoma
Differentiated thyroid carcinoma (DTC) is not an uncommon tumour in Thailand.1 A high percentage of 10-year survival results in long-term follow-up. I-131 total-body scan (I-131 TBS) is commonly used for monitoring the disease after surgery and radioiodine ablation in most centres.
This article is available only as a PDF. Please...
Others
A Case Report of Neurologically Unstable Fracture of the Lumbosacral Spine in a Patient with Ankylosing Spondylitis
Ankylosing spondylitis is associated with progressive ossification of the spinal ligaments and ankylosing of the facet joints leading to a totally stiff spine. It is often associated with osteoporosis due to chronic inflammation and disuse.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
Embolisation of a Renal Artery Pseudoaneurysm in a Patient with Renal Malrotation and Chronic Aortic Dissection
A 40-year-old Chinese male presented with severe right loin pain. He had a history of chronic abdominal aortic dissection of unknown aetiology. He was not hypertensive and there was no evidence of ankylosing spondylitis, Ehlers-Danlos syndrome or any connective tissue disorder.
This article is available only as a PDF. Please...
Original Article
Single Centre Review of Radiologically-guided Percutaneous Nephrostomies: A Report of 273 Procedures
Percutaneous nephrostomy (PCN) is a well-established technique in the armamentarium of an interventional radiologist when dealing with urinary obstruction. It provides temporary relief in obstructive uropathy and stabilises the patients for subsequent definitive treatment.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Original Article
To Establish the Normal Bone Mineral Density Reference Database for the Singapore Male
Bone mineral densitometry was developed as a means to quantify the bone mineral content of the skeleton accurately and has been used in the diagnosis of osteopenia and osteoporosis. Dual-energy X-ray absorptiometry (DXA) of the axial skeleton is one such technique2 which is based on a subtraction method.
This article...
Original Article
Percutaneous Vertebroplasty in the Management of Osteoporotic Vertebral Compression Fractures: Initial Experience
With the general increase in life expectancy in the local population, the incidence of osteoporosis is anticipated to rise as well. Even with screening modalities such as bone mineral densitometry and preventive treatment such as hormone replacement therapy, many patients are asymptomatic and are diagnosed with osteoporosis only after...
Original Article
Differentiation of Malignant Vertebral Collapse from Osteoporotic and Other Benign Causes Using Magnetic Resonance Imaging
An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult to differentiate between benign and malignant causes for the vertebral collapse.
This article is available only as a PDF. Please click on “Download PDF” on top...
Original Article
Osteoporotic Hip Fractures in Singapore—Costs and Patient’s Outcome
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 need for hospitalisation and surgery, represents an important economic burden to society, in addition to its medical morbidities and social implications upon the patient and...
Original Article
Outcomes of Acute Arthroscopic Repair and Conservative Treatment Following First Traumatic Dislocation of the Shoulder Joint in Young Patients
Traumatic dislocation of the shoulder is a serious problem especially in active and young patients. Shoulder instability and recurrent dislocation hinder patient activities.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Letter to the Editor
We would like to draw the attention of your readers to the comments made in the editorial of the recent Imaging issue of your journal.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
From Genesis to Genes
I would like to thank the Singapore Orthopaedic Association (SOA) for inviting me to deliver this year’s SOA lecture. When your President, Dr AK Mitra first asked me to deliver the lecture, I felt deeply honoured but was rather hesitant about accepting it – honoured as this annual lecture...
Others
Imaging-guided Bone Biopsy
Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety of modalities, such as fluoroscopy1 and computed tomography (CT), and less commonly, ultrasonography (US) and magnetic resonance (MR) imaging.
This article is available only as a...
Others
Carcinoma of the Cervix: Role of MR Imaging
In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each year in both developing and industrialised nations, with a higher incidence in women of low socioeconomic status.
This article is available only as a PDF. Please...
Others
Intracerebral Schwannoma—A Rare Cause of Epilepsy
Schwannomas are extra-axial neoplasms derived from the nerve sheath of peripheral or cranial nerves. They represent approximately 8% of all intracranial tumours, arising predominantly from the vestibular nerve.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Radiographic Features of a Case of Severe Acute Respiratory Syndrome with Fatal Outcome
Severe acute respiratory syndrome (SARS) is an atypical pneumonia that was first reported in early 2003. Reports of outbreaks of cases rapidly appeared in Hong Kong, Vietnam, China and Singapore.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Clinical Applications of MR Cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) has attracted a lot of interest from clinicians because it is a non-invasive method of obtaining a cholangiographic image without the morbidity that is associated with endoscopic retrograde cholangiopancreatography (ERCP).
This article is available only as a PDF. Please click on “Download PDF” on top to...
Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Clinical Positron Emission Tomography Imaging—Current Applications
Like other radionuclide techniques, positron emission tomography (PET) is based on the tracer principle – a small amount of labelled ligand is used to trace the metabolic pathway of an important chemical in the cell. PET complements anatomic imaging by its ability to map function or metabolism.
This article is...
Review Article
MR Imaging and MR Spectroscopy of Adenocarcinoma of the Prostate
Prostate cancer is usually suspected due to an abnormal digital rectal examination, elevated serum prostate specific antigen (PSA) level or both. The diagnosis of prostate cancer depends on histopathologic examination of tissue obtained from systematic sextant core needle biopsy under transrectal ultrasound guidance.
This article is available only as a...
Review Article
Imaging of Congenital Middle Ear Deafness
When a child or young adult with morphologically normal external ears and no previous history of ear discharge or trauma presents with conductive hearing deficit, a congenital middle ear anomaly should be sought. Although fenestral otosclerosis is a differential diagnosis, the early onset of symptoms and a lack of...
Review Article
MR Imaging of the Fetal Brain and Spine: A Maturing Technology
The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Imaging of Acquired Immunodeficiency Syndrome (AIDS)
The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of death worldwide. There are now 60 million deaths recorded from the infection worldwide by the United Nations AIDS (UNAIDS) organisation, most of them in sub-Saharan...
Review Article
The Singapore National Breast Screening Programme: Principles and Implementation
In January 2002, the first population-based national mammographic breast screening programme in Asia, the Singapore National Breast Screening Programme (BreastScreen Singapore), was launched. The programme aims to achieve international standards of breast screening practice and breast cancer detection, as well as to reduce or stabilise the mortality from breast...
Original Article
Brachiocephalic-Superior Vena Cava Metallic Stenting in Malignant Superior Vena Cava Obstruction
A large majority of superior vena cava (SVC) syndrome is caused by malignancy (74% to 95%). This can either be due to direct SVC invasion or secondary to extrinsic compression.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Pilot Study Using Technetium-99m Pertechnetate Sequential Radionuclide-Sialography to Assess Salivary Gland Function in Nasopharyngeal Cancer Patients on Radiation Therapy
Nasopharyngeal carcinoma (NPC) is an epithelial malignancy occurring worldwide with particularly high frequencies in the Far East. The incidence is highest in Hong Kong followed by Singaporean Chinese.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Breath-hold Fast Recovery Fast Spin Echo versus Conventional Non-Breath-hold Fast Spin Echo T2-Weighted MR Imaging of Focal Liver Lesions
T2-weighted magnetic resonance (MR) imaging is an important sequence for characterisation of focal liver lesion. Accurate characterisation of benign lesions, such as haemangioma or cyst, is important to prevent unnecessary procedure or surgery.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Original Article
Diffusion-weighted MR Imaging in Intracranial Infections
Diffusion-weighted magnetic resonance (MR) imaging (DWMRI) is becoming essential to the assessment of acute cerebral infarction and has also been applied to distinguish cerebral abscess from necrotic intracranial neoplasm. There have also been a few case reports on DWMRI of encephalitis.
This article is available only as a PDF. Please...
Original Article
Preoperative High Resolution CT and MR Imaging in Cochlear Implantation
Candidates for cochlear implantation undergo a thorough audiological and medical assessment. The audiological assessment is done to ensure that these candidates who have bilateral profound or severe hearing loss have been given adequate hearing amplification, but show no significant benefit.
This article is available only as a PDF. Please click...
Original Article
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of the mammogram remains the basic policy, as was recommended in the Forrest report.
This article is available only as a PDF. Please click on “Download PDF”...
Original Article
Breast Cancer in Women Under 40 Years: Preoperative Detection by Mammography
The incidence of breast cancer peaks between the ages of 45 and 55 years. Approximately 7% of breast cancers occur below 40 years of age.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Editorial
The Past Decade of Diagnostic Radiology in Singapore: How Much Progress Have We Really Made?
It has been 10 years since the first ever issue of Annals dedicated to “Radiology” was published in Volume 22 No. 5 September 1993. Keeping in mind the tremendous growth in the development and applications of Imaging for both Diagnosis and Intervention, this second theme issue is long overdue.
This...
Others
Book Review
A lot of young orthopaedic surgeons embark on research projects with little guidance. This book is especially directed towards young investigators in the Southeast Asian region.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Significance of the Lateral Epiphysis of the Acetabulum to Hip Joint Stability
Developmental dysplasia of the hip (DDH) remains one of the most difficult disorders to understand and treat in Paediatric Orthopaedics. The aetiology have not been clearly understood and therefore the management remains controversial.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
Colorectal cancer is the second most common cancer in Singapore, accounting for 15.9% of all cancers registered with the Singapore Cancer Registry in the years between 1993 and 1997. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer.
This article...
Original Article
Computed Tomographic Appearance of Colorectal Hepatic Metastases
It is important to recognise the computed tomography (CT) appearance of hepatic metastases from colorectal primaries, as resection in a selected group may offer a 20% to 40% rate of five-year survival compared to 5% to 10% with non-surgical management.
This article is available only as a PDF. Please click...
Review Article
Current Status in Imaging of Colorectal Liver Metastases
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the time of clinical presentation, with an additional 30% developing clinical evidence of hepatic disease within 24 months.
This article is available only as a PDF. Please...
Others
Routine Abdominal and Pelvic Ultrasound Examinations: An Audit Comparing Radiographers and Radiologists
Since its introduction into clinical practice in the early 1970s, ultrasound (US) has become firmly established as an extremely valuable imaging modality and widely used to the extent that abdominal US is the second most commonly performed imaging study (after chest radiography). Our department has also experienced a steady...
Original Article
Clinical Utility of Selective Intra-arterial Calcium-stimulated Hepatic Venous Sampling in Regionalisation of Insulinomas—The Singapore Experience
Insulinomas are small tumours with dimensions that seldom exceed 2.0 cm in diameter. Preoperative non-invasive localisation using trans-abdominal ultrasound and conventional computed tomography (CT) detect only between 25% and 60% of insulinomas.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Others
Reflections of a Septuagenarian – Radiology: Past, Present and Future
Before I commence, I would like to thank the Singapore Radiological Society and the Chapter of Radiologists of the Academy of Medicine for inviting me to speak today on the occasion of the inauguration of the FY Khoo Lectureship. I was initially hesitant.
This article is available only as a...
Others
Imaging Findings in Acute Neck Infection due to Pyriform Sinus Fistula
Pyriform sinus fistula is a developmental abnormality of the 3rd or 4th branchial pouch. It usually presents in childhood as acute inflammatory swelling of the neck and frequently involves the thyroid gland.
This article is available only as a PDF. Please click on “Download PDF” on top to view the...
Original Article
Audit of Diagnostic and Interventional Craniocervical Catheter Angiographic Procedures at the Singapore General Hospital
Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast and spatial resolution, as well its high selectivity and ability to show the full extent of vascular disease, presence of contralateral disease, patterns of collateral...
Original Article
Breast Ultrasound in Women With Familial Risk of Breast Cancer
Mammography is the modality of choice to screen for breast cancer in asymptomatic women. However, it is known that about 10% to 12% of breast cancers are mammographically occult.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Condensing Osteitis of the Medial Clavicle – An Intermediate-term Follow-up
Condensing osteitis of the clavicle is an idiopathic condition affecting the medial end of the clavicle, and is characterised by sclerosis and expansion of the inferior part of the clavicular head. The rarity of this disorder is highlighted by the experience of the senior author (SN Bell).
This article is...
Review Article
Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging
Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there has been a dramatic increase in the survival rate of patients.
This article is available only as a PDF. Please click on “Download PDF” on top...
Others
A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia
Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000 deliveries.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Plantar Dislocation of Lateral Tarsometatarsal Joint: A Case of Subtle Lisfranc Injury
Lisfranc fracture dislocations are uncommon injuries and the diagnosis may be easily missed. There are several variations and we present one such variant.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Thoracic Myelopathy Secondary to Ligamentum Flavum Ossification
Acquired thoracic spinal canal stenosis is an uncommon condition compared to myelopathy and radiculopathy frequently seen in the cervical and lumbar spine, respectively. Because the rib cage restricts its movement, the thoracic spine is less prone to degenerative changes in the disc and facet joints, which result in loss...
Original Article
Rising Trend of Anterior Cruciate Ligament Injuries in Females in a Regional Hospital
Female athletes are at a greater risk for injuries involving the anterior cruciate ligament (ACL) than their male counterparts in high schools and colleges in the United States. Noyes et al reported that 78% of all ACL injuries were non-contact in nature and they most often occurred on landing...
Others
Profunda Femoris Artery Pseudoaneurysm Presenting with Triad of Thigh Swelling, Bleeding and Anaemia
Pseudoaneurysms of the profunda femoris artery have been reported following blunt and penetrating trauma to the thigh, and orthopaedic procedures of the proximal femur. These pseudoaneurysms can present in various forms, such as a painful pulsatile mass, or even thigh compartment syndrome.
This article is available only as a PDF....
Original Article
Cancellous Screw Fixation for Femoral Neck Fractures: One Hundred and Sixteen Patients
The incidence of hip fractures rises with increasing age, doubling for each decade beyond 50 years of age. With the increase in life expectancy and the accompanying ageing population, there has been an increase in the incidence of hip fractures from 1.17 per 1000 females >60 years old in...
Original Article
Deep Vein Thrombosis Following Hip Fracture and Prevalence of Hyperhomocysteinaemia in the Elderly
Western literature reports a high incidence of deep vein thrombosis (DVT) after hip surgery in the absence of prophylaxis. It is reported to be as high as 50% of which 20% to 30% are in the proximal vein.
This article is available only as a PDF. Please click on “Download...
Original Article
Septic Arthritis after Arthroscopic Anterior Cruciate Ligament Reconstruction
Arthroscopic-guided reconstruction of the anterior cruciate ligament (ACL) is now recognised as the preferred reconstructive option in restoring anterior knee joint stability. According to a report by the American Academy of Orthopedic Surgeons on ACL reconstruction in October 2000, approximately 50,000 ACL surgeries were performed each year in the...
Original Article
Morbidity Following Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft
Rupture of the anterior cruciate ligament (ACL) impairs the stability of the knee, resulting in difficulty with athletic performance, increased risk of subsequent meniscal injury and increased risk of degenerative joint disease. Reconstruction of the ACL is a frequently performed procedure used to restore functional stability in ACL-deficient knees,...
Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
This article is available...
Original Article
Semi-Quantitative Measurements of Normal Organs With Variable Metabolic Activity on FDG PET Imaging
Positron emission tomography (PET) has a proven clinical role in oncology, cardiology and neurology that primarily uses 2-deoxy-2--fluoro-deoxyglucose (FDG). FDG is an analogue of glucose that mimics the cellular uptake and initial metabolism of glucose, which enables cells utilising excess glucose to be visualised. Increased glucose metabolism is commonly...
Review Article
Clinical Applications of Positron Emission Tomography in Cardiology: A Review
Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a poor prognosis when treated medically.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
The Role of FDG-PET in the Management of Non-small Cell Lung Carcinoma
Carcinoma of the lung is the leading cause of cancer death in both men and women and is the second most common malignancy in both men and women. In 2003, it is estimated that there will be 171,900 new cases of lung carcinoma diagnosed in the United States and...
Review Article
Clinical PET Imaging – An Asian Perspective
Positron emission tomography (PET) is distinct from other imaging modalities in its ability to probe the physiology and biochemistry of normal and abnormal tissues. It is based on the same principle of tracer kinetics used in conventional nuclear medicine.
This article is available only as a PDF. Please click on...
Review Article
PET Tracers and Radiochemistry
Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in large part, to advances in instrumentation and synthetic chemistry.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
Physical Principles and Technology of Clinical PET Imaging
The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The emergence of PET as the functional imaging modality of choice for diagnosis, staging, therapy monitoring and assessment of recurrence in cancer has led to an...
Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...
Original Article
Use of D-dimer and Lower Extremity Doppler Ultrasound Results to Obviate the Need for Computerised Tomographic Pulmonary Angiography
The diagnosis of pulmonary embolism (PE) can be a challenging problem. It depends on clinical suspicion and the interpretation of a combination of clinical and radiological presentations.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Radiofrequency (RF) ablation for the treatment of focal liver malignancies is a relatively new image-guided procedure that is gaining increasing acceptance in the radiologic and surgical community, particularly as an alternative treatment option for patients who have inoperable tumours. The potential benefits of minimally invasive image-guided ablation, as compared...
Editorial
Building Collaboration in Cardiac Imaging
Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery disease (CAD) detection has captured the imagination of the public appears exceptional.
This article is available only as a PDF. Please click on “Download PDF” on...
Others
3rd FY Khoo Memorial Lecture – Education, Professionalism, Outsourcing and the Future of Radiology
Radiology is undergoing unprecedented changes. Not only is the technology evolving rapidly, providing images of breathtaking anatomical clarity, but functional information has also become a reality.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Review Article
Singapore National Medical Image Resource Centre (SN.MIRC): A World Wide Web Resource for Radiology Education
Radiological images are critical for diagnosis, teaching and research. In radiology education, learners must be exposed to large amounts of visual information, and assimilation of these medical images is essential in the training of diagnostic skills.
This article is available only as a PDF. Please click on “Download PDF” on...
Review Article
Teleradiology in Singapore – Taking Stock and Looking Ahead
Teleradiology is the electronic transmission of radiologic images from one location to another for the purposes of interpretation and/or consultation. The current interest in teleradiology is fuelled mainly by rapid technological advances, a worldwide shortage of radiologists, and cost considerations in developed countries.
This article is available only as a...
Original Article
Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore
Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection from close contact.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Necrotising Fasciitis and Traditional Medical Therapy – A Dangerous Liaison
The first case was a 54-year-old lady, with a history of insulin-dependent diabetes mellitus and hyperlipidaemia, who presented with bilateral hand pain and stiffness of 4 days’ duration.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
A Case of Cystic Schwannoma of the Lesser Sac
Schwannoma or neurilemmoma (NL) is a well-defined, usually benign, tumour arising from the nerve sheath (Schwann cell). It may present as a solitary mass in any part of the body, but is more commonly seen in the head and neck, the extremities and on the trunk.
This article is available...
Original Article
A Review of Clinical Pathway Data of 1663 Total Knee Arthroplasties in a Tertiary Institution in Singapore
Total knee arthroplasty (TKA) has been established as an effective treatment modality for patients with symptomatic knee arthritis. It provides predictable decrement in pain, correction of deformity and improved functional outcomes.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Letter to the Editor
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...
Images in Medicine
“Bone Block” and Congenital Spine Deformity
A 14-year-old female who presented with a limited range of neck motion with various congenital vertebral anomalies that included improper segmentation or extensive “fusion” of the cervical spine, hemivertebrae, and a right rigid convex thoracolumbar scoliosis (Figs. 1 and 2). She was diagnosed with Klippel-Feil syndrome (KFS) with congenital...
Original Article
Autologous Bone Marrow Plasma Injection after Arthroscopic Debridement for Elbow Tendinosis
Elbow tendinosis is a term used to describe a syndrome of pain involving the extensor or flexor tendon origin of the forearm musculature. It is a common problem in adults and it is called “medial” or “lateral epicondylitis” depending on the site of involvement.
This article is available only as...
Letter to the Editor
Primary Hydatid Disease of the Humerus
Hydatid disease is a parasitic tapeworm infection caused by Echinococcus species. E.granulosus and E.alveolaris are the most common causes of hydatid disease in humans.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Others
Magnetic Resonance Imaging of Sports Injuries of the Knee
Sports-related knee injuries are common, with contact sports and sports involving twisting movements being the most frequent causes. Sports injuries may affect any of the knee structures, including ligaments, menisci, bones, cartilage and periarticular soft tissues.
This article is available only as a PDF. Please click on “Download PDF” on...
Original Article
Recurrent Patellar Dislocation: Reappraising our Approach to Surgery
Traumatic patellar dislocations affect mainly adolescents and young adults. Up to 44% of patients will develop recurrent dislocation.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Triple Endobuttton Technique in Acromioclavicular Joint Reduction and Reconstruction
Acromioclavicular joint (ACJ) dislocation is a common injury often affecting young athletes. Cyclist, ice hockey players, weight lifters, rugby players and martial exponents are the most common athletes sustaining the injuries.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full...
Original Article
Return to Sports After Anterior Cruciate Ligament Reconstruction – A Review of Patients with Minimum 5-year Follow-up
Complete anterior cruciate ligament (ACL) rupture results in a mechanically unstable knee. ACL reconstruction is recommended in athletes to help restore knee stability for return to pivoting sports.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Clinical Evaluation of Arthroscopic-assisted Allograft Meniscal Transplantation
The menisci of the knee are fibro-cartilaginous structures essential for the normal biomechanic of the knee joint. They play a critical role in shock absorption, load transmission, joint lubrication and congruency, nutrition, stability of the knee and facilitating the rotation of the opposing articular surfaces of the joint.
This article...
Letter to the Editor
Renal Cell Carcinoma Bony Metastasis Treatment
Patellar metastases are extremely rare, ironically, primary tumours of the patella are more common than metastatic disease. A Medline search from 1960 to the present yielded only 23 reported cases of patellar metastases.
This article is available only as a PDF. Please click on “Download PDF” on top to view...
Review Article
Osteochondral Lesions of the Talus
Osteochondral lesions of the talus are a known cause of chronic ankle pain. They are frequently found in the active population after ankle sprains.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian countries.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Medical Misadventure: Barium Extravasation in Colorectal Cancer
Double contrast barium enema (DCBE) is a safe and accurate diagnostic procedure for colorectal cancer. It is often the next diagnostic test after incomplete colonoscopy, with an additional diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the non-visualised portion of the colon.
This article is available...
Original Article
The Natural History and Prognosticative Factors of Adult Extremity Soft Tissue Sarcomas: An Asian Perspective
Soft tissue sarcomas (STSs) are extremely rare tumours, making up about 1% of all malignancies. In Singapore, they accounted for 0.7% of all cancers in males and 0.5% of all cancers in females with 217 case presentations in the period between 1998 and 2002.
This article is available only as...
Letter to the Editor
Durian Seed Masquerading as Gallstone Ileus on Computed Tomography
Bezoars and gallstones are unusual causes of small bowel obstruction, with well-described imaging features on CT. We present a case of intestinal obstruction caused by a laminated mass in the terminal ileum that resembled a gallstone on CT, but was surgically proven to be a durian seed phytobezoar.
This article...
Letter to the Editor
An Unexpected Outcome following Radial Head Excision for Jeffrey Type II Fracture-Dislocation of the Proximal Radius in a Child
We present a case of a 10-year-old child who sustained a traumatic fracture-dislocation of his proximal radius and subsequently underwent surgical removal of the radial head. At 3 years of follow-up, he had regained full painless flexion and extension with loss of pronosupination.
This article is available only as a...
Original Article
A Survey of Local Preclinical and Clinical Medical Students’ Attitudes towards Radiology
Radiology is not a popular specialty for undergraduate student electives or postgraduate training amongst students from a local undergraduate medical school which is based in Southeast Asia. During the last 2 years (2007 & 2008), none of our elective students came from the local undergraduate medical school. During the...
Letter to the Editor
Primary Epithelioid Angiosarcoma of the Lung Presenting as Left-sided Shoulder Pain
Primary angiosarcoma of the lung is a rare, often difficult to diagnose disorder with non-specific respiratory manifestations. Angiosarcoma involving the lung is usually a result of metastatic disease.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Effect of Autologous Mesenchymal Stem Cells on Biological Healing of Allografts in Critical-sized Tibial Defects Simulated in Adult Rabbits
Bridging of large bone defects is a challenging problem in orthopedic and reconstructive surgery. Options include vascularised bone autografts, non-vascularised bone autografts, allografts, bioceramics and custom-made prostheses.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Letter to the Editor
Macronodular Tuberculosis: Imaging Resemblance of Cholangiocarcinoma
The ability of multiphasic computed tomography (CT) and magnetic resonance (MR) studies in the diagnosis of liver tumours such as hepatocellular carcinoma and cholangiocarcinoma is well established. Nevertheless, potential mimics of malignant tumours abound. Hepatic tuberculosis presenting as hepatic mass is rare and preoperative diagnosis is usually difficult without...
Original Article
The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms
Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...
Original Article
Central Clot Score at Computed Tomography as a Predictor of 30-day Mortality after Acute Pulmonary Embolism
Multi-detector Computed Tomography (MDCT) pulmonary angiography is currently the method of choice for the detection of acute pulmonary embolism (PE), because of its convenience, speed, sensitivity, direct clot visualisation and ability to provide alternative diagnoses that mimic PE clinically.
This article is available only as a PDF. Please click on...
Original Article
Vascular Endothelial Growth Factor (VEGF) is Expressed During Articular Cartilage Growth and Re-expressed in Osteoarthritis
Growth factors are polypeptides that direct cells to proliferate, differentiate, migrate or produce matrix. They exert their effects by interacting with specific receptors on the surfaces of cells.
This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.
Original Article
Effectiveness of Vacuum-assisted Closure (VAC) Therapy in the Healing of Chronic Diabetic Foot Ulcers
Diabetes mellitus is a common problem in Singapore, with an incidence of 8.2% in the local population aged between 18 and 69 in 2004. Ten per cent to 25% of diabetics developed foot ulcerations.
This article is available only as a PDF. Please click on “Download PDF” on top to...
Others
Chronic Achilles Tendon Rupture Treated with Two Turndown Flaps and Flexor Hallucis Longus Augmentation – Two-year Clinical Outcome
Chronic Achilles tendon rupture is a disabling condition resulting in ankle pain, weakened ankle plantarflexion and abnormal gait. Management of chronic ruptures is technically challenging with generally poorer outcomes and higher complication rates than that of acute repair. Current literature suggests this problem is still better tackled surgically although...
Images in Medicine
Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?
A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron
emission tomography/computed tomography (PET/CT) for staging. Figure 1 demonstrates a whole body maximal intensity projection image while Figures 2 and 3 show cross-sectional images through the elbows...
Letter to the Editor
Lemierre’s Syndrome: An Unusual Cause of Calf Abscess
Dear Editor,
Lemierre’s syndrome is a rare disease caused by Fusobacterium necrophorum, a Gram-negative anaerobic bacillus that is associated with oropharyngeal infections. We describe a case of a 16-year-old male presenting with acute calf abscess caused by an unusual organism, Fusobacterium necrophorum. Based on our review, this is the first...
Original Article
Electrocardiograph Changes, Troponin Levels and Cardiac Complications After Orthopaedic Surgery
Following orthopaedic surgery, approximately 5% of patients sustain cardiac complications which leads to increased morbidity and mortality. The mortality rate after hip fracture is as high as 10% to 26% at 6 months and cardiac-related death are common. Cardiac injury is potentially treatable and therefore early detection of myocardial...
Original Article
Unipolar versus Bipolar Hemiarthroplasty for Displaced Femoral Neck Fractures in the Elderly: Is There a Difference?
Hip hemiarthoplasties are commonly performed for displaced femoral neck fractures. The advantages of hemiarthroplasty over internal fixation include earlier mobility, less reoperations and better functional outcome at 1 year.
Considerable differences of opinion exists regarding the choice between unipolar and bipolar designs. The main theoretical advantage of a bipolar over...
Letter to the Editor
Use of the Sole Flap to Convert an Above Knee Amputation to a Below Knee Amputation in Trauma
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...
Letter to the Editor
Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion
Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive pathology lies anterior to the spinal cord – prolapsed intervertebral discs (PID), ossified posterior longitudinal ligament (OPLL), spondylodiscitis and retropulsion of fractured bony fragments. More...
Letter to the Editor
Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy—The Way Forward
I read with great interest the recent article published in the Annals of Academy of Medicine Singapore entitled, ‘Surgeon-Performed Ultrasound-Guided Fine Needle Aspiration Cytology (SP-US-FNAC) Shortens Time for Diagnosis of Thyroid Nodules, Ann Acad Med Singapore 2014;43:320-4’. Indeed, ultrasound-guided fine-needle aspiration (US-FNA) is an exceptionally valuable and simple approach...
Original Article
Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms
Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS) that affect quality of life and it causes structural and functional changes in the bladder. Previous clinical guidelines had emphasised on managing symptoms; however current...
Original Article
Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?
The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...
Letter to the Editor
A Follow-up Longitudinal Survey on a Cohort of Undergraduate Medical Students’ Attitudes towards Radiology
As a follow-up to an earlier study comparing the attitudes of first year undergraduate medical students following the introduction of a new radiology curriculum in 2008 with their clinical seniors who did not have an early exposure to radiology; we again surveyed this same cohort of first year students...
Commentary
Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging
Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit into various tissues and organs, the process invariably leads to organ dysfunction. Deposition of amyloid fibrils into the heart results in cardiac amyloidosis (CA). Manifestations...
Commentary
Optimum early orthopaedic surgery in COVID-19 patients
Multiple guidelines have been established regarding the management of COVID-19 patients. However, there remains a paucity regarding specific guidelines on the optimal timing for surgeries in COVID-19 patients requiring early orthopaedic surgery. This paper aims to provide evidence-based recommendations regarding the timing to proceed with early orthopaedic surgeries in...
Original Article
Transscaphoid Perilunate Fracture/Dislocations—Results of Surgical Treatment
Transscaphoid perilunate fracture/dislocations are relatively uncommon injuries of the wrist, constituting about 3% of all carpal injuries. However, it accounts for more than half of perilunate dislocations, the dorsal variant being by far the more prevalent.
This article is available only as a PDF. Please click on “Download PDF” on...