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Tragus pressure-guided removal of airway devices for safe emergence from sedation: A randomised controlled trial

Dear Editor, Emergence from anaesthesia and deep sedation is the transition from unconsciousness to the return of awareness and airway reflexes. The chief patterns of...

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...

Response to letters arising from publication of the Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

Dear Editor, The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an...

Sedation in gastrointestinal endoscopy in Singapore

Dear Editor, I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use...

Non-anaesthesiologists administering propofol in the Singapore context

Dear Editor, Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid...

Sedation by non-anaesthesiologists in gastrointestinal endoscopy

Dear Editor, We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy...

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

Dear Editor, Symptomatic haemorrhoids is the most common anorectal disorder, where up to 75% of people experience symptoms sometime in their lives.1 The current gold standard...

Mesothelial Splenic Cyst—A Case Report

Non-parasitic cystic lesions of the spleen are unusual. They are classified essentially as primary (true, epithelial) and secondary (pseudo, non-epithelial) based on the presence...

Pericardial Injury Following Severe Sepsis from Faecal Peritonitis—A Case Report on the Use of Continuous Cardiac Output Monitoring

The intermittent manual bolus thermodilution method is the most common means of determining cardiac output in critically ill patients. Although widely used, there are...

An Overview of Anaesthetic Issues in Phaeochromocytoma

New developments in technology, monitoring and pharmacology over the last decade have improved our understanding of phaeochromocytoma and its management. This review summarises the...

Is it Feasible to Use Magnesium Sulphate as a Hypotensive Agent in Oral and Maxillofacial Surgery?

Although deliberate hypotension during surgery may potentially cause organ ischaemia, in particular of the myocardium and cerebrum, it is widely used as an adjuvant...

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

The prevalence of human immunodeficiency virus (HIV) infection is rising at an exponential rate in Singapore. The surgical experience with this disease remains limited. This...

Postanaesthetic Shivering—A Comparison of Thiopentone and Propofol

The incidence of shivering following general anaesthesia varies from 5% to 65%. Postanaesthetic shivering may increase tissue oxygen demand by as much as 500%...

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

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

Sudden Profound Hypoxaemia in the Intensive Care Unit—A Case Report

Significant arterial hypoxaemia is defined as a partial pressure of oxygen (PaO2) that is less than 60 mmHg or a percentage of oxyhaemoglobin (%...

Ambulatory Anorectal Surgery—Is it Feasible Locally?

Economic and social pressures are compelling surgeons to modify their practice. An increasing number of procedures are being done in an outpatient setting. This article...

Management Training in Critical Care Medicine

Critical care medicine as a specialty has grown rapidly, both clinically and academically, over the past 25 years. In the USA, certification of competence...

Combined High-frequency Ventilation (CHFV) in the Treatment of Acute Lung Injury—A Case Report

The role of ventilatory support in acute lung injury is supportive, whilst the damage to alveolar-capillary membranes resolves and alveolar stability is restored. The...

Critical Care Medicine in the Western Pacific Region

The Western Pacific region includes a very diverse group of countries varying in their culture, economic development and per capita income, disease prevalence and...

Critical Care—The Worldwide Perspective

Although special areas for postoperative patients existed 50 years ago, the modern specialty of Critical Care began during the polio epidemic of the 1950s....

Caudal Morphine in Paediatric Patients: A Comparison of Two Different Doses in Children after Major Urogenital Surgery

The use of caudal preservative-free morphine for postoperative analgesia in children has gained popularity since it was first described by Jensen. Several studies have...

Predictors of Long-term Outcome in Severe Head Injury

Injuries form the fifth commonest cause of death locally. They accounted for 27 out of 100 000 deaths in 1993. This article is available only...

Audit of 2431 Admissions to the Surgical Intensive Care Unit, Singapore General Hospital

The Singapore General Hospital is a 1700-bedded tertiary hospital with subspecialty intensive care units (ICUs), i.e. Surgical ICU, Cardiothoracic ICU, Neurosurgical ICU, Medical ICU,...

Intensivists for the Intensive Care Unit—Do They Make a Difference?

Does Critical Care Medicine exist and what defines its area of practice? Different countries have embarked on their own journeys of discovery, and have...

Epidural Analgesia in Obstetrics

Most obstetric anaesthetists have their favourite epidural concoction for use in labour, This paper surveys the variation in techniques of drug delivery and types...

Phyllodes Tumour: An Update of 40 Cases

First described by Johannes Muller in 1838 as a large, benign tumour of the breast. Phyllodes tumour is a rare pathological entity, accounting for...

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

Thyroid nodule is a common problem in surgical practice. In 1994, more than 350 thyroid operations were performed in our department, of which 183...

The Role for Preoperative Localisation Techniques in Surgery for Hyperparathyroidism

Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented...

Medicine and Surgery—History, Change and Challenge

Mr Koh Yong Guan, guest-of-honour; Dr Tan Ser Kiat, Master, Academy of Medicine; Dr K C Tan, Chairman, Chapter of Surgeons; Dr Robert Jalleh...

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

Doran, in 1903, reported the first case of adrenal cyst described by Greiselius in 1670. It was not until 1966 that Foster reported the...

An In vitro Evaluation of Epidural Catheters: Tensile Strength and Resistance to Kinking

In the current era of increasing economic and medicolegal pressures, it is imperative that equipment-related limitations and complications be reduced to a minimum. Epidural...

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

Thoracoscopy was first introduced by Jacobaeus nearly a century ago. With the development of endoscopic equipment and the recent surge of interest in minimally...

Focused Abdominal Sonography for Trauma (FAST)

The multiply injured patient presents a challenge to even the most experienced surgeon. These patients often present in shock and require a rapid diagnostic...

Use of EMLA Cream or Alfentanil for Analgesia during Ophthalmic Nerve Blocks

Cataract surgery is performed mainly as day-case surgery, with the majority performed under regional anaesthesia. Retrobulbar block, combined with facial nerve block, provides good...

The Use of Magnesium Sulphate in the Intensive Care Management of an Asian Patient with Tetanus

A 29-year old Thai construction worker, previously well, was admitted to our Orthopaedic Department for sudden onset of lower back pain. Physical examination showed...

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

Alternative medicine has become widely publicised throughout the world. Alternative medicine practitioners (AMPS), which include Oriental medicine doctors, traditional Chinese medicine practitioners, naturopaths and...

Re-expansion Pulmonary Oedema Following One-lung Ventilation —A Case Report

A 15-year-old female patient weighing 40 kg with asymptomatic but severe scoliosis was admitted for correction of a skeletal deformity via a thoracoscopic anterior...

Changing the Institutional Practice of Prolonged Mechanical Ventilation after Coronary Artery Bypass Graft Surgery to Early Extubation

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists...

Controversies in Anaesthesia—Designer Drugs

The discovery of new drugs in anaesthesia previously relied completely on chance. Chemical compounds produced by pharmaceutical companies were screened by a variety of...

Diagnosing and Managing Faecal Incontinence

Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of...

1998 Distinguished Academician Lecture: Hepatic Resection— A Western Perspective

Although debridement of portions of liver that prolapsed through war wounds was recorded from distant times, attempts at resection of a solid liver tumour...

Radial Nerve Injury after Intravenous Cannulation at the Wrist—A Case Report

A 44-year-old male, right-handed and ASA 1 bus driver presented for elective mastoidectomy under general anaesthesia. Preoperative venous cannulation with a 20G cannula (Angiocath™)...

Dissemination of Respiratory Secretions During Tracheal Tube Suctioning in an Intensive Care Unit

Tracheal tube suctioning is frequently performed in critically ill patients. This procedure often results in dissemination of droplets from the patient’s respiratory tract with...

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

Colour image analysers have been extensively used in medical research since 1970 for histomorphometric studies. Image analysis gives more information and a better understanding...

Immunological Consequences of Trauma and Shock

Despite intensive research and intervention, trauma continues to be the leading cause of death during the first three decades of life in the USA,...

The Viability of Liver Graft for Transplantation After Prolonged Warm Ischaemia

Liver transplantation (LTx) is the treatment of choice for many patients with end stage liver disease. However liver allograft availability prevents its widespread application. This...

Perioperative Wheezing—A Report of Three Cases

Perioperative “wheezing” can be due to upper or lower airway obstruction. The signs and sounds of upper airway obstruction are typically worse during inspiration,...

The Use of the Laryngeal Mask Airway in Post-Tonsillectomy Haemorrhage—A Case Report

A 53-year-old man with a history of hypertension and asymptomatic Wolff-Parkinson-White syndrome was admitted to the hospital for an elective uvulopalatopharyngoplasty, tonsillectomy and bilateral...

Extended Resection of Locally Advanced (T4) Stomach Cancer

Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years,...

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

Inguinal hernia is one of the commonest surgical pathologies in the world. Laparoscopic totally extraperitoneal repair has been gaining popularity in recent years. This article...

A Case Report of the Use of Magnesium Sulphate during Anaesthesia in a Patient who had Adrenalectomy for Phaeochromocytoma

Phaeochromocytomas are catecholamine-secreting tumours of the chromaffin cells of the body derived from neural crest tissue. They may secrete both adrenaline and noradrenaline in...

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

Beginning in 1991, the Department of Forensic Medicine (DFM), which undertakes all Coroner’s casework locally, embarked on an on-going review of Coroner’s perioperative autopsies...

Prophylactic Esmolol Infusion for the Control of Cardiovascular Responses to Extubation after Intracranial Surgery

Both intubation and extubation are processes associated with blood pressure and heart rate flux. While many studies have been carried out on the changes...

Transurethral Surgery and the Adductor Spasm

Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of...

Subcutaneous Emphysema and Pneumomediastinum after Endotracheal Anaesthesia

Pneumomediastinum is a well-recognised clinical entity. It may present either intraoperatively or postoperatively from a number of possible causes. This article is available only as...

Microdochectomy for Single-duct Nipple Discharge

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

Total Intravenous Anaesthesia Using 3-in-1 Mixture of Propofol, Alfentanil and Mivacurium

Total intravenous anaesthesia (TIVA) implies achieving the 3 components of anaesthesia (hypnosis, analgesia and muscle relaxation) by the administration of anaesthetics via the intravenous...

The Predictive Value of Intraoperative ST-segment Monitoring as a Marker of Myocardial Injury

Patients with ischaemic heart disease have a high incidence of perioperative ischaemia resulting in an increased risk of cardiac events in the post-surgical period.1...

Perioperative and Rehabilitative Outcomes after Amputation for Ischaemic Leg Gangrene

In the last century, Sir William Ferguson said: “amputation—one of the meanest and yet one of the greatest operations in surgery: mean, where resorted...

Adverse Operative Risk Factors for Perforated Peptic Ulcer

Although there has been a significant decline in elective surgery for peptic ulcer disease with the introduction of H-2 blocker, the incidence of peptic...

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

Firstly may I thank the Academy of Medicine and the Chapter of Surgeons for giving me this great privilege and honour to deliver the...

Results of Surgical Resection of Oesophageal Carcinoma in Singapore

Although the incidence of oesophageal carcinoma is declining, it still remains a common cancer in Singapore. From 1988 to 1992, it was the ninth...

Fibre-optic Aided Bougie (FAB) for Simulated Difficult Tracheal Intubation

Difficult intubation remains a key problem1 and the value of a flexible introducer (gum elastic or wire) as a first approach is well recognised...

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

Thyroglossal duct remnant is one of the most common lesions of the anterior midline neck. It occurs in 7% of adults1 and carcinoma is...

A Case Report on the Treatment of Intractable Anal Pain from Metastatic Carcinoma of the Cervix

Unremitting pain remained a primary therapeutic challenge in cancer patients. Both opioids and non-opioids are often the main stay of therapy for many. This article...

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

On a global basis, the use of ultrasonography to assist clinicians in obtaining timely diagnoses in abdominal trauma is not particularly new. The first...

Intravenous Regional Anaesthesia Using Lignocaine and Tramadol

Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the...

The Alvarado Score and Acute Appendicitis

Acute appendicitis is a common surgical emergency. However, it is often difficult to make an accurate preoperative diagnosis, especially during the early stage of...

Catheter-related Infection: Diagnosis, Prevention and Treatment

Intravascular catheters are indispensable for patient care. Despite advances in catheter technology and patient care, catheter infection remains a significant clinical problem. This article is...

Book Review

This handbook serves an important function for Intensive Care Units in Singapore. It is a collective effort of 35 specialists in 5 different institutions...

Anaemia in the Critically Ill—The Optimal Haematocrit

The function of haemoglobin (Hb) is to transport oxygen to the tissues. Approximately 97% of oxygen is transported via Hb, while 3% is transported...

Quality of Life in Long-Term Survivors of Intensive Care

Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying...

Limitation of Life Support in the Critically Ill: The Hong Kong Perspective

Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly...

Simulation-based Training at the University of Pittsburgh

In the domain of medical education of both the general public and healthcare professionals, the next decade will present both challenges and opportunities centred...

Retinol Palmitate Counteracts Oxidative Injury During Experimental Septic Shock

Gram-negative bacteria induced septic shock, a condition with high mortality, is frequently seen in critical care medicine. The wall of gram-negative bacteria consists of...

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

Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While...

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

Mucinous cystadenoma of the vermiform appendix is an uncommon entity. It is a benign lesion but may disseminate and lead to the development of...

Pulse Dye Densitometry: A Novel Bedside Monitor of Circulating Blood Volume

The monitoring of circulating blood volume (CBV) is important in the care and management of critically ill patients. Progressive blood volume depletion, if unmonitored...

Case Report: Catheter-Related Epidural Abscess

Epidural abscess complicating epidural catheterisation was first reported in 1974. Two recent studies indicated a local infection incidence of epidural catheters of 4.3% to...

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

Over the past decade, sonography as a screening tool in the evaluation of abdominal trauma has been thoroughly investigated. This modality was first used...

Stapled Haemorrhoidectomy—The Evidence For and the Facts Against

Surgeons as well as patients have recently shown much interest in stapled haemorrhoidectomy. This is a new technique, which is claimed to result in...

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

The recorded history of breast cancer management spans four millennia. This story about breast cancer management is also one about change, about resistance to...

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

Internal hernia is defined as the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. This...

A Case of Pulmonary Haemorrhage Following Jet Ventilation for Vocal Cord Surgery

Laryngospasm occurring at extubation is not an uncommon complication seen with use of endotracheal tubes and laryngeal mask airway. We report a case of...

Subdural Block—From a Spinal? A Case Report

There have been multiple reports of accidental subdural blocks published in the last 20 years. Majority of these have been the result of an...

Problems Related to Epidural Analgesia for Postoperative Pain Control

Epidural analgesia has been shown to provide excellent pain relief following thoracotomy, abdominal and other surgery. Studies have shown improvement in specific variables with...

Clinical Update on Managing the Obstructed Airway

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

Anaesthetic Considerations for Lung Volume Reduction Surgery—A Case Report

Only until a few years ago, the only surgical alternative for patients with severe emphysema was lung transplantation. However, with transplantation, there are problems...

Emergency Laparoscopic Surgery—The Changi General Hospital Experience

Today, laparoscopic surgery has achieved widespread acceptance among surgeons as well as the general public. Emergency laparoscopic procedures (ELPs) have been performed since the...

Surgical Management and Outcome of Carotid Body Tumours

The carotid body was first described by von Haller in 1743. It is often a small ovoid or irregular mass composed of compact pinkish...

Hepatolithiasis —A Case Series

Intrahepatic biliary stone or hepatolithiasis is an uncommon entity worldwide, with a higher incidence in East Asia in comparison to the West. As yet,...

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

Acute ischaemia of the bowel is a devastating condition. Recently published figures on mortality range from 30% to 60%. This article is available only as...

Remifentanil in the Management of Laparoscopic Resection of Phaeochromocytoma – Case Reports

The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...

A Prospective Audit of Critical Incidents in Anaesthesia in a University Teaching Hospital

Despite the highest standards of training, practice and equipment, morbidity and mortality due to anaesthesia still occur. These risks are difficult to quantify, and...

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

Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy...

Practical Issues in Adjuvant Therapy for Rectal Cancer

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

Total Mesorectal Excision (TME) – Twenty Years On

In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing...

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

It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal...

Academy of Medicine, Singapore clinical guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting

The practice of gastrointestinal (GI) endoscopy over the last 3 decades has seen both a rise in volume of routine procedures, and an increase...

Ensuring safe sedation during gastroendoscopy

Gastrointestinal (GI) endoscopy started in Singapore in 1968 with diagnostic endoscopic gastric examination, using flexible fibre-optics GI endoscopy. Fibre-optic flexible sigmoidoscopy and colonoscopy were...

Inflammatory Fibroid Polyp of the Caecum in a Patient with Neurofibromatosis

Inflammatory fibroid polyp is an uncommon nonneoplastic lesion found in the gastrointestinal tract. It is a benign, non-encapsulated submucosal lesion, composed mainly of loose...

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

Next year, we celebrate a hundred years of medical education in Singapore. We have come a long way since 1821 – from a small,...

Littoral Cell Angioma of the Spleen

The littoral cells line the vascular channels of the red pulp of the spleen and have characteristics of endothelial and histiocytic cells. In 1991,...

Marijuana in Pregnancy

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

Transmission of Tuberculosis from Patient to Healthcare Workers in the Anaesthesia Context

Tuberculosis poses a very real problem to healthcare workers (HCWs). In Singapore, the prevalence of tuberculosis in the general population remains high at 44...

An Unexpected Left Hydrothorax after Left Internal Jugular Venous Catheterisation for Total Parental Nutrition and Antibiotics

Percutaneous indwelling central venous catheters are commonly used for a variety of medical and surgical indications. There are various complications associated with the insertion...

The Impact of Experiential Learning on NUS Medical Students: Our Experience With Task Trainers and Human-patient Simulation

The realisation that students have different cognitive and learning styles has had major implications on medical curriculum design efforts. If the student’s learning style...

Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum

Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with...

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

The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely...

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

Buprenorphine, more commonly known as Subutex (Reckitt Benckiser Pharmaceuticals), has been released in Singapore since 2002. Initially marketed as an opiate substitute to help...

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

In clinically-oriented subjects such as surgery, specific guidelines for conducting small group teachings are lacking. Different methods are being practiced and researched in different...

Successful Management of an Iatrogenically-ingested Sharp Foreign Body

A 37-year-old man with no significant medical history underwent dental treatment. An injection dental needle used in the course of root canal treatment came...

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...

Advanced Burkitt’s Lymphoma Presenting With Jejunal Perforation

Burkitt’s lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin’s lymphomas. It is predominantly seen in children but may also...

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

Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain...

Multimodal prehabilitation before major abdominal surgery: A retrospective study

Ageing is one of the biggest public health concerns of the 21st century, presenting a challenge to the practice of medicine globally. As the...

Reply from Author: Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters

We thank Dr Nicholas Chua et al for their interest in our review article. We agree and appreciate the experience and comments by the...

Intrathecal Analgesia for Cancer Pain: Externalised Intrathecal Catheters

We thank the authors for a comprehensive review on the role of interventional pain therapies used in cancer pain as well as a informative...

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

Peritoneal dissemination of hepatocellular carcinoma (HCC) is a rare presentation, with an incidence of 2% to 6% detected during autopsy or laparoscopy. Although uncommon,...

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

Colorectal cancer (CRC) is one of the commonest cancers worldwide with age standardised incidence rates of 22.8 to 64.2 and 19.0 to 46.7 per...

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

The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent...

Emergency Surgery for a Ruptured Intra-abdominal Desmoid Tumour

Desmoid tumours are fibrous benign tumours that are often indolent until local symptoms evolve. We highlight a rare case of a ruptured intra-abdominal desmoid...

Lower limb nodules

A 45-year-old Chinese woman with no medical history or regular medications presented with painful nodules on her left shin that progressed to involve her...

A pedunculated mass of the thigh

A 61-year-old Chinese woman presented to the general surgery clinic for a long-standing lump over her proximal medial right thigh. The painless lump was...

Recommendations for standards of neuromuscular monitoring during anaesthesia

Dear Editor, We presented recommendations for neuromuscular monitoring during anaesthesia, which were approved by the Council of the College of Anaesthesiologists, Singapore in September 2019...

Acute Marjolin’s Ulcer: A Forgotten Entity

Marjolin’s ulcers are malignancies that arise from areas of chronic irritation or injury that undergo malignant transformation after a period of many years. Such...

Evidence-Based Guidelines on the Use of Opioids in Chronic Non-Cancer Pain—A Consensus Statement by the Pain Association of Singapore Task Force

Studies show that the incidence of chronic pain is approximately 18% in Australia and developed countries in Europe. In Asia, data from Hong Kong...

The Use of Complementary and Alternative Medicine in Chronic Pain Patients in Singapore: A Single-Centre Study

Chronic pain is a prevalent disease that is often diffi cult to manage. According to a World Health Organisation survey, the worldwide prevalence of...

Management Plan to Reduce Risks in Perioperative Care of Patients with Obstructive Sleep Apnoea Averts the Need for Presurgical Polysomnography

A significant proportion of patients with underlying obstructive sleepapnoea (OSA) remain undiagnosed when they present for surgery. Epidemiologic data have placed the prevalence in the...

200 years of surgery at the General Hospital, Singapore

Western medicine in Singapore began with Sir Stamford Raffles’ arrival on 28 January 1819 with a sub-assistant surgeon, Dr Thomas Prendergast, providing medical care...

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

Dear Editor, Low-grade fibromyxoid sarcoma (LGFMS) is a rare form of neoplasm that usually occurs in the deep soft tissue of the lower limbs with...

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

A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC...

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

Over the past few decades, the introduction of laparoscopic surgery has been the biggest game changer in abdominal surgery.1 However, although the first laparoscopic...

Laparoscopic liver resection: Global diffusion and learning curve

Laparoscopic liver resection (LLR) is being utilised with increasing frequency worldwide, as initial concerns about the safety and feasibility of LLR, such as the...

Prehabilitation and Its Role in Geriatric Surgery

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As...

New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore

Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown....

Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy

Oesophageal cancer is the 7th most common cancer in the world, with 572,034 new cases diagnosed in 2018, and is the 6th most common...

A survey of Singapore anaesthesiologists for practice and prevention of peri-operative hypothermia in adult surgical patients

Core temperature is the temperature of blood and internal organs; influenced by biorhythm, metabolism, activity and hormones. It is regulated within a narrow range,...

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

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB)...

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

In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which...

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

Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was...

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

Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted...

Penile preserving surgery in penile cancer management

Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates...