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Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation

The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and...

Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation

Atrial fibrillation (AF) is the most common clinically significant arrhythmia and is associated with increased risks of stroke, dementia, heart failure (HF) and death.1...

Different strokes for different folks

Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven...

Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction

Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to...

Impact of sex and diabetes in patients with heart failure with mildly reduced ejection fraction

With increasing global awareness of sex differences in the heart failure population and the new entity of heart failure with mildly reduced ejection fraction...

Iatrogenic atrial septal defect after catheter ablation—to close or not to close?

Dear Editor, Transseptal access to the left heart is increasingly performed for electrophysiological procedures and for structural heart disease interventions such as balloon mitral valvuloplasty...

Cardiac sarcoidosis: Difficulties in diagnosis and treatment

Sarcoidosis is a multisystem, granulomatous disorder of unknown aetiology. It affects the lungs in 90% of cases, but is also known to affect other...

Out-of-hospital cardiac arrest in Singapore: Can we do better?

Cardiac arrests are unpredictable events that frequently result in death or significant residual morbidity among survivors. These sudden events affect not only the individual,...

Sepsis and cardiovascular events: The story so far

Sepsis is a state of life-threatening organ dysfunction that results from a dysregulated host immune response to infection.1 Sepsis is a common condition that...

Previous history of hyperthyroidism in emergency department patients with atrial fibrillation does not increase the risk of thromboembolism and death

Dear Editor, Atrial fibrillation (AF) is frequently encountered in the emergency department (ED) and is a major risk factor for thromboembolic events. The clinical decision...

Pressures, indexes and peripheral arterial disease: Time to rethink our approach?

Most patients with peripheral arterial disease (PAD) are asymptomatic. Despite the absence of symptoms, these patients have a significantly increased risk of death and...

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...

A Case Report of Heparin Resistance due to Acquired Antithrombin III Deficiency

Intravenous heparin therapy is used in the management of angina and myocardial infarct with increasing frequency in recent years. Those patients who have been...

Cryptococcal Prostatic Abscess in an Immunocompromised Patient: A Case Report and Review of the Literature

Cryptococcosis is a well-recognised infection in immunocompromised patients, although its prevalence varies with the type of immune defect. We report a patient with myasthenia...

Cutaneous Polyarteritis Nodosa: A Case Report and Literature Review

Cutaneous polyarteritis nodosa (CPN) is an uncommon form of vasculitis of the small-and medium-sized arteries in the reticular dermis and subcutaneous tissue. It remains...

Sezary Syndrome: A Case Report and a Review of the Molecular Pathomechanism and Management

Our patient is a 64-year-old Malay man who first presented in July 1993 with a history of rash starting on the hands 1½ years...

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

Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy. This...

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...

Creutzfeldt-Jakob Disease Presenting with Visual Blurring, Diplopia and Visual Loss: Heidenhain’s Variant

The electroencephalographic pattern is distinctive in many but not in all patients with Creutzfeldt-Jakob disease (CJD). Often, it is one of diffuse and non-specific...

Case Series of Bronchoscopic Removal of Tracheobronchial Foreign Body in Six Adults

Gustav Killian reported the first case of bronchoscopic removal of foreign body (FB) from the trachea in 1897. Since then, rigid bronchoscopy under general...

Drug Treatment of Hypercholesterolaemia

Serum cholesterol has been established as a major risk factor for coronary heart disease (CHD). There is a linear association between serum cholesterol level...

Goldberger’s Triad in Dilated Cardiomyopathy—Can it Predict the Severity of Left Ventricular Dysfunction?

In 1982, Goldberger described a novel electrocardiogram (ECG) triad that was highly specific for patients with dilated cardiomyopathy and congestive heart failure (attributable to...

Thyroid Storm Presenting as Jaundice and Complete Heart Block

Thyroid storm is defined as a severe and often life-threatening exacerbation of thyrotoxicosis which is usually characterised by hyperthermia, tachycardia, severe agitation and altered...

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

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is...

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

A remarkable variety of endocrinologic disorders may cause virilization syndromes. This can pose a diagnostic dilemma to even the most experienced clinicians. This article is...

Pelvic Spleen Masquerading as an Ovarian Neoplasm

A 53-year-old Caucasian woman, a receptionist in a general practice, was referred to the gynaecology outpatient clinic with an 18-month history of heavy, irregular...

Repair of Complex Ureterovaginal and Vesicovaginal Fistulas with Ileal Cystoplasty and Ureteric Reimplantation into an Antireflux Ileal Nipple Valve—A Case Report

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

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

To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer. This article...

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 (%...

Hyperthyroidism with Gynaecomastia as the Initial Complaint: A Case Report

Gynaecomastia is not a commonly recognised feature among the myriad symptoms and signs associated with hyperthyroidism. A review of the literature disclosed only eight...

Rosai-Dorfman Disease with Primary Cutaneous Manifestations—A Case Report

In 1969, Rosai and Dorfman first described a newly recognised benign systemic histioproliferative disease characterised clinically by bilateral striking cervical lymphadenopathy, fever, leukocytosis, and...

The Alien Hand Sign–Case Report and Review of the Literature

The alien hand sign or “strange hand sign”, first coined by Brion and Jedynak in 1972, refers to a feeling that the hand is...

Simultaneous Transcatheter Valvuloplasty and Amplatzer Septal Occlusion for Pulmonary Valvar Stenosis and Secundum Atrial Septal Defect

Congenital pulmonary valvar stenosis (PVS) and secundum atrial septal defect (ASD) are relatively common forms of congenital heart disease (CHD). Since the first successful...

A Case of Metastatic Nasopharyngeal Carcinoma in Benign Nasal Polyps

Our patient was a 39-year-old Chinese man with nasopharyngeal carcinoma (NPC) presenting initially with right upper cervical lymphadenopathy. He was treated primarily with a...

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...

Thoracoscopic Thymectomy for Myasthenia Gravis: A Case Report

Total thymectomy is the established surgical therapeutic method for generalised myasthenia gravis. Several approaches are used for the surgical removal of the thymus and...

Electrocardiographic Abnormalities in Combined Hypercalcaemia and Hypokalaemia—Case Report

The electrocardiographic abnormalities in isolated hypercalcaemia and hypokalaemia have been well documented in the literature. However, electrocardiogram (ECG) findings in combined hypercalcaemia and hypokalaemia...

A Case Series of Ocular Disease as the Primary Manifestation in Sarcoidosis

Sarcoidosis is an idiopathic, systemic, non-caseating, granulomatous disease with protean clinical manifestations. Although the first description of sarcoidosis was attributed to Hutchinson, its ocular...

A Case of Pseudohyperkalaemia and Thrombocytosis

Hyperkalaemia is a common biochemical derangement in the intensive care unit reflecting a diversity of systemic perturbations such as acute renal failure, rhabdomyolysis, extracellular...

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...

Five Paediatric Case Reports of the Use of Adenosine in Supraventricular Tachycardia

Adenosine has been shown to be effective in terminating supraventricular tachycardia in adults and children. However, the use of adenosine has not been previously...

A Case Series of Paget’s Disease of Bone: Diagnosing a Rather Uncommon Condition in Singapore

Sir James Paget’s description in 1877 of “a form of chronic inflammation of bones” which now bears his name was based entirely on clinical...

Ergotism and Vascular Insufficiency: A Case Report and Review of Literature

Toxicity from ergot and its derivative is well known. Great epidemics occurred during the middle ages due to consumption of rye contaminated with the...

Systemic Sclerosis in DRw52-positive Silica-exposed Males: A Case Report

Familial scleroderma was first documented in 1953 by Rees and Bennett who described the occurrence of a localised disease in a father and daughter....

Subclavian-oesophageal Fistula as a Complication of Foreign Body Ingestion: A Case Report

Ingested foreign bodies are a common condition in the practice of Otolaryngology. In particular, there is no doubt a greater tendency in the local...

A Case Report of a Patient with Bronchial Carcinoid Tumour and Late Presentation of Cushing’s Syndrome

Cushing’s syndrome is usually easy to recognise clinically. Determining the cause of non-iatrogenic Cushing’s syndrome is, on the other hand, often a diagnostic enigma. This...

Traumatic Dislocation of the Testes

Traumatic dislocation of the testes is uncommon. The first case was reported by Claubry in 1818 in Paris, when a 20-year-old soldier was run...

A Case of Accelerated Development of Proliferative Diabetic Retinopathy in a Woman with Type 2 Diabetes Mellitus after Pregnancy

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

Trilateral Retinoblastoma—A Case Report

Retinoblastoma is the third most common tumour in childhood. It is inherited genetically. This article is available only as a PDF. Please click on “Download...

Recurrent Gigantic Pyogenic Granuloma Disturbing Speech and Mastication: A Case Report and Literature Review

Pyogenic granulomas are common benign fibrovascular growths of the oral cavity that are non-neoplastic in nature. They may also present as skin lesions. This article...

Verrucous Haemangioma—A Case Report

Verrucous haemangioma is an uncommon congenital vascular malformation which may grow to large sizes. It has a characteristic hyperkeratotic and verrucous surface which resembles...

Interventional Electrophysiology and its Role in the Treatment of Cardiac Arrhythmia

Cardiac arrhythmias are disorders of the electrical system of the heart which can present as benign ectopics or as life-threatening arrhythmias and sudden cardiac...

A Case of Sulindac-induced Enteropathy Resulting in Jejunal Perforation

Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for the treatment of various rheumatic conditions including rheumatoid arthritis (RA). The adverse effects of NSAIDs on...

Musculoskeletal Pain Clinic in Singapore—Sacroiliac Joint Somatic Dysfunction as Cause of Buttock Pain

Patient A, a 33-year-old male administrative coordinator presented with left buttock pain of 4 to 5 years duration which radiated down to the leg...

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...

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...

Incessant Ectopic Atrial Tachycardia and Tachycardia-related Cardiomyopathy: Therapeutic Options and Potential for Cure

Incessant ectopic atria tachycardia (IEAT) is a rare and insidious arrhythmia which is frequently misdiagnosed and if untreated, leads to ‘exhaustion’ of the myocardium...

A Case Report of Adult T-Cell Leukaemia/Lymphoma (ATLL)

Our patient was a 71-year-old Chinese man who presented with a 6-year history of recurrent papular erythematous eruptions to the dermatologist. This article is available...

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...

Chronic Subdural Haematoma Presenting with Transient Ischaemic Attacks— A Case Report

Transient ischaemic attacks (TIA) are commonly seen in neurologic practice. They are most commonly associated with cerebrovascular insufficiency, either from a thrombotic or embolic...

Chryseobacterium meningosepticum (Flavobacterium meningosepticum)—A Report of Five Cases in a Local Hospital

Chryseobacterium meningosepticum has been known to be a causative agent of meningitis particularly in the premature and newborn infants. The first case of human...

Bullous Dermatomyositis Associated with Nasopharyngeal Carcinoma —A Case Report

Bullous dermatomyositis is a rare variant of dermatomyositis and has been reported in the literature. It is believed to be strongly associated with the...

Case Reports of Linear IgA Bullous Dermatosis of Childhood

Linear IgA bullous dermatosis of childhood (LADC) is an acquired subepidermal blistering disorder of young children which is characterised by the unique finding of...

Atypical Mycobacterium Infection with Sporotrichoid Spread in a Patient with Human Immunodeficiency Virus

Mycobacteria other than tubercle bacilli (MOTT) were shown to be agents of human disease in the 1950s. They are also known as atypical, environmental...

Intracoronary Brachytherapy: The Beginning of the End of Restenosis?

Restenosis remains a major clinical problem 20 years after the introduction of coronary angioplasty by Andreas Gruentzig in the treatment of coronary artery disease....

The Effect of Fenofibrate on Insulin Sensitivity and Plasma Lipid Profile in Non diabetic Males with Low High Density Lipoprotein/Dyslipidaemic Syndrome

Hyperinsulinaemia and insulin resistance have been postulated to relate directly to both hypertension and coronary artery disease in type II diabetes and possibly also...

Midface Distraction Osteogenesis in Cleft Patients: A Case Report

The aetiology of midfacial hypoplasia in patients with cleft lip and palate has been attributed in the literature to the surgical procedures used for...

A Case Report of a Vital Replanted Tooth with Unfavourable Extra-alveolar Condition: A 10-Year Follow-up

Tooth avulsion, frequently of the maxillary central incisors, occurs most often in children from 7 to 9 years of age, when the periodontium surrounding...

Odontoameloblastoma: Report of a Case

Ameloblastoma is a benign but locally invasive tumour that affects the jaws. Although it is commonly regarded as a homogeneous group of tumours, detailed...

Oral Manifestations of Schimmelpenning Syndrome: Case Report and Review of Literature

Schimmelpenning syndrome (SS) is characterised by specific skin manifestations, skeletal defects, and central nervous system abnormalities, such as mental deficiency and seizures. Happle has...

Selective Laser Sintering: Application of a Rapid Prototyping Method in Craniomaxillofacial Reconstructive Surgery

The value of computed tomography (CT) in craniofacial trauma is now well established with progress in imaging modalities. Three-dimensional (3-D) CT has changed the...

Disseminated Penicillium marneffei Infection: A Report of Five Cases in Singapore

Penicillium marneffei is a dimorphic fungus that can cause infection in immunocompromised hosts. Reports on infection with this organism were initially uncommon, but after...

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...

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...

Selective Serotonin Reuptake Inhibitor Discontinuation Symptoms

Selective serotonin reuptake inhibitors (SSRIs) are a new class of antidepressants which are effective, better tolerated with less side effects and more specific in...

Palatal Myoclonus—A Case Report

Palatal myoclonus is a rare movement disorder characterised by rhythmic recurring jerky movements of the soft palate, pharynx, larynx and rarely diaphragm, trunk and...

Soft Tissue Chondroma in the Finger: A Case Report and Review of the Literature

Chondromas are the most common bony tumours in the hand. However, soft tissue chondromas are relatively uncommon entities. This article is available only as a...

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...

A Case Series of Falciparum Malaria-induced Acute Renal Failure

Predominantly a disease of hot and humid climates, malaria affects 270 million people worldwide annually, and has a mortality rate of 1%. The increasing...

Eccrine Porocarcinoma: A Case Report

Porocarcinoma is a rare malignant tumour, arising from the intra-epidermal ductal portion of the eccrine sweat gland, also known as “acrosyringium”.’ According to the...

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...

Bilateral Caudate Infarct—A Case Report

The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply...

Homocysteine and Atherosclerotic Disease: The Epidemiologic Evidence

Homocysteine is a thiol-containing amino acid formed during the metabolism of methionine. The metabolic fate of homocysteine may be influenced by the alterations in...

T Wave Alternans and Acute Rheumatic Myocarditis: A Case Report

T wave alternans, an electrical cardiac alternans in which there is a beat-to-beat variation in the amplitude, shape or the polarity of the T...

Trends in Mortality, Incidence, Hospitalisation, Cardiac Procedures and Outcomes of Care for Coronary Heart Disease in Singapore, 1991-1996

In line with trends in many high-income countries, Singapore has experienced some declines in mortality from coronary heart disease (CHD) since the 1980s. Whether...

Acute Mercury Vapour Poisoning in a Shipyard Worker—A Case Report

Despite improvements in industrial working conditions, mercury remains second only to lead as a cause of heavy metal poisoning. Cases of poisoning by inhaled...

Hepatopulmonary Syndrome: A Rare Complication of Chronic Liver Disease in Children

Children with chronic liver disorders may present with dysfunction of other organ systems. Encephalopathy, gastrointestinal bleeding, failure to thrive and impaired renal function are...

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™)...

Case Report: Percutaneous Balloon Dilatation and Ureteral Stenting for Tuberculous Renal Infundibular and Ureteral Strictures

The management of the non-functional tuberculous kidney is controversial and ranges from surgical intervention to conservative treatment. Intra-renal scarring with stricture formation is common...

Extensor Pollicis Longus Paralysis Following Thoracoscopic Sympathectomy

A 24-year-old man was referred for hyperhidrosis of more than 15 years duration. It affected both hands, feet and axilla. This article is available only...

Echocardiographic Features and Management of Neonatal Ductal Aneurysm

Previously thought to be a rare condition, aneurysms of the ductus arteriosus have been increasingly reported in the medical literature over the past few...

An Unusual Tumour Metastasis to the Cervix

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

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,...

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...

A Case Report: Persistent Acantholytic Dermatosis in Chronic Renal Failure

A 70-year-old Chinese man with end-stage renal failure (ESRF), who has been on continuous ambulatory peritoneal dialysis for 6 months, was referred by the...

Beneficial Effect of Combination Therapy with Ozagrel and Pranlukast in Exercise-induced Asthma Demonstrated by Krypton-81m Ventilation Scintigraphy—A Case Report

Exercise is a common stimulus of bronchoconstriction in subjects with asthma. Exercise-induced asthma is a temporary increase in airway resistance that occurs after several...

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...

Primitive Neuroectodermal Tumour of the Chest Wall—A Report of Two Cases and Review of Literature

Tumours of the chest wall are uncommon and are usually sarcomatous in nature. Primitive neuroectodermal tumours (PNETs) are rare and are thought to arise...

Squamous Cell Carcinoma arising in a Cutaneous Epidermal Cyst—A Case Report

Epidermal cysts are common benign subcutaneous lesions. Malignant transformation in epidermal cysts is a rare but recognised occurrence. This article is available only as a...

Otogenic Lateral Sinus Thrombosis—A Case Report

A 16-year-old boy, with a background history of beta-thalassaemia intermedia, splenectomy and hypogonadotrophic hypogonadism, was referred to our otolaryngological clinic for right otalgia following...

Initial Experience With an Autocapture Pacemaker System

The longevity of a pacemaker generator varies directly with the total deliverable amount of electrical charge (Q, in coulombs) and inversely with the rate...

Case Report of Staphylococcus lugdunensis Native Valve Endocarditis and Review of the Literature

Coagulase-negative staphylococci cause 5% of native valve endocarditis. Of the 30 species identified currently, Staphylococcus epidermidis is a well-recognised cause of native valve endocarditis;...

The Differential Diagnosis of Supraventricular Tachycardia Using Clinical and Electrocardiographic Features

Noninvasive evaluation of the mechanism of the arrhythmia is important in the management of supraventricular tachycardia (SVT). It guides one in the choice of...

Case Reports: The Use of Intermaxillary Screws to Achieve Intermaxillary Fixation in the Treatment of Mandibular Fractures

The mandible is a unique bone in the human skeleton and occupies a prominent position in the craniofacial region. Traumatic injury to the face,...

Pseudomembranous Tracheobronchitis Caused by Aspergillus in a Patient after Peripheral Blood Stem Cell Transplantation

Pseudomembranous tracheobronchitis caused by Aspergillus is a rare and lethal variant of invasive aspergillosis. It has been reported in a few series of immunocompromised...

Treatment of Chronic Urticaria with Thyroxine in an Euthyroid Patient with Thyroglobulin and Microsomal Antibodies

Chronic urticaria is defined as daily outbreaks of urticaria of at least 6 weeks duration. Despite being a common disorder, the cause of chronic...

Hard Metal Lung Disease—The First Case in Singapore

A 38-year-old Chinese man and lifetime non-smoker, who had previously been well, was referred for investigation of bilateral reticulonodular infiltrates noted on his chest...

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...

Sandhoff Disease—A Case Report of 3 Siblings and a Review of Potential Therapies

Sandhoff disease is a rare inborn error of metabolism characterised by the absence of both β-hexosaminidase A and B, resulting in an accumulation of...

A Case Report on the Perinatal Management of a 30-week Preterm Baby with Congenital Complete Heart Block

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is...

Cardiac Marker Point-of-care Testing: Evaluation of Rapid On-site Biochemical Marker Analysis for Diagnosis of Acute Myocardial Infarction

In the present era of revascularisation therapy, rapid and accurate diagnosis of acute myocardial infarction (AMI) is important, as these patients may benefit from...

Cardiovascular Disease: Genes and Public Health

The excitement surrounding the Human Genome Project and its impending completion has raised expectations of the possibilities for genetics in common disease. It is...

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...

Candida Arthritis in a Premature Infant Treated Successfully with Oral Fluconazole for Six Months

Candida arthritis in premature infants is regarded as a rare condition. The largest published series of 8 cases from one institution was from Bombay,...

An Unusual Case of Cutaneous Vasculitis

A 49-year-old Chinese man presented at the Tan Tock Seng Hospital with painful gangrene of the right second and left third and fourth toes...

A Case Report of Aspergillus Hypersensitivity Syndrome with Obstructing Bronchial Aspergillosis

The spectrum of pulmonary aspergillosis includes saprophytic colonisation, hypersensitivity syndromes and invasive lung disease. There has been a tendency to classify these syndromes as...

Upper Airway Resistance Syndrome—Report of Three Cases

Sleep-related breathing disorders are widely recognised as important causes of morbidity and mortality over the past 3 decades. The obstructive sleep apnoea syndrome (OSAS)...

Incidence of Ischaemic Heart Disease and Stroke in Chinese, Malays and Indians in Singapore: Singapore Cardiovascular Cohort Study

Comparisons of disease frequency in different ethnic groups help to unravel the contributions of nature and nurture in their aetiology and to identify environmental...

Technetium-99m Sestamibi for the Assessment of Myocardial Salvage Following Reperfusion Therapy in Acute Myocardial Infarction

Reperfusion therapy for acute myocardial infarction is feasible with thrombolytic therapy as well as acute percutaneous transluminal coronary angioplasty (PTCA). Both modalities of treatment...

Initial Experience of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Paediatric Patients

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations,...

Muscle Dysmorphia in a Young Chinese Male

In 1891, Morselli described “dysmorphophobia” in 78 patients who were severely miserable, preoccupied and distressed by perceived deformities. The word “dysmorphia” in Greek means...

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

Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of...

Active Management of a Patient with Endstage Pulmonary Emphysema Using Lung Volume Reduction Surgery and Intensive Rehabilitation

A 65-year-old Chinese man with a 30-pack year history of cigarette smoking was referred to our institution for further management of chronic obstructive pulmonary...

Case Reports of Nocardiosis in Patients with Human Immunodeficiency Virus (HIV) Infection

Nocardiosis is an infection caused by a soil-borne aerobic filamentous bacterium in the genus Nocardia and the order Actinomycetales. Within the genus Nocardia, N....

Neonatal Lupus Erythematosus: Our Local Experience

Neonatal lupus erythematosus (NLE) is related to the transplacental passage of anti-Ro antibodies from mother to foetus. The commonest manifestations involve the skin and...

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...

Endobronchial Mass in a Patient with Burkholderia pseudomallei Infection

The diagnosis of Burkholderia pseudomallei infection is based on culture of clinical specimens such as blood or other body fluids, or serology using indirect...

Lichen Amyloidosus: A Bullous Variant

Systemic amyloidosis, first reported in 1886, is characterised by deposits of amyloid in various organs including the skin, which may manifest as skin purpura,...

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

Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000...

Pericarditis and myocarditis after COVID-19 mRNA vaccination in a nationwide setting

The coronavirus disease 2019 (COVID-19) pandemic has resulted in much morbidity and mortality worldwide. The development of mRNA vaccines has heralded much hope in...

Shigella Septicaemia in Adults: Report of Two Cases and Mini-Review

Shigellosis is generally considered to be confined to the gastrointestinal tract. Septicaemic infections with Shigella species are extremely rare in adults. This article is available...

Human Immunodeficiency Virus Infection Presenting with Chronic Actinic Dermatitis: A Case Report

A 40-year-old Chinese man of skin phototype III (Table I), formerly a welder in a shipyard, presented with pruritic papules on his face, neck...

Listeria Meningoencephalitis: Two Cases and a Review of the Literature

The general experience of local physicians and available data suggest that listerial infections of the central nervous system (CNS) are uncommon among adults in...

Histoplasmosis Presenting with Progressively Worsening Backache—A Case Report

A 55-year-old man presented with intermittent low back pain of 2 months’ duration which was progressively worsening, fever, anorexia and a 10-kg weight loss....

Panhypopituitarism due to Pituitary Cyst of Rathke’s Cleft Origin—Two Case Reports

Rathke’s cleft cysts are non-neoplastic cystic epithelial lesions of the sellar and suprasellar region which are thought to originate from the remnants of Rathke’s...

Two Cases of Medullary Thyroid Carcinoma

A 44-year-old Indian man was found to have a raised carcinoembryonic antigen (CEA) (49.5 μg/L) detected on routine medical examination in February 2000....

Bilateral Synchronous Renal Oncocytoma: A Case Report and Review

Oncocytomas are neoplasms characterised by large epithelial cells with finely granular eosinophilic cytoplasm called oncocytes. They were first described by Zippel in 1942 and...

Reduction Mammaplasty in the Surgical Management of a Giant Breast Hamartoma: Case Report

Large benign tumours of the breast cause gross enlargement with compression of normal breast tissue. Following removal of the tumour, the affected side has...

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...

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

Hepatocellular carcinoma (HCC) is one of the most malignant tumours. The lack of an effective treatment modality has stimulated the use of selective internal...

Isolated Non-compaction of Ventricular Myocardium: A Report of Three Cases

Non-compaction of ventricular myocardium is a rare morphogenic arrest of compaction of the ventricular myocardial fibres during intrauterine life. Usually, the left ventricle is...

Ossifying Lipoma of the Hand: A Case Report

Lipomata are one of the most common benign tumours in adults, occurring in almost any location of the human body, especially in the subcutaneous...

Impairment of Endothelial Function—A Possible Mechanism for Atherosclerosis of a High-fat Meal Intake

The impairment of endothelial vasodilatory function has been considered an early event in atherogenesis. This has been studied in association with various cardiovascular risk...

A Rare Cause of Syncope in a Patient with Diabetes Mellitus—A Case Report

Hypoglycaemia is a common medical emergency. It presents either with symptoms of neuroglycopaenia, such as episodes of visual blurring, confusion, convulsions and sometimes coma...

Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome

There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic...

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...

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

Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours. This...

46, XY Female—A Case Report

The phenotypic sex of an individual is usually male if that person’s genotype is 46, XY since the SRY gene on the Y chromosome,...

A Case Report of Primary Hyperparathyroidism with Severe Bony Involvement and Nephrolithiasis

Primary hyperparathyroidism is said to have evolved from a disease of “bones, stones and groans”, to one that is largely asymptomatic with a relatively...

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 Case of Alpha-Fetoprotein-Producing Gastric Cancer

A 57-year-old accountant presented to her doctors in a neighbouring country in early October 1998 with problems of easy bruising, bleeding gums, one single...

Case Report: Acute Tumour Lysis Syndrome

Acute tumour lysis syndrome (ATLS) is one of the most urgent of all oncological treatment-related complications. It has a broad impact on organ dysfunction,...

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...

Melioidosis Splenic Abscess—An Unusual Presentation as Osteomyelitis of Rib

A 74-year-old Chinese gentleman first presented in February 1999 with an abscess over his left lower chest. He was treated for pulmonary tuberculosis in...

Liver Transplantation in a Child With Severe Hypercholesterolaemia in Alagille Syndrome

Alagille syndrome (AS) or arteriohepatic dysplasia is a genetic disorder transmitted in an autosomal dominant inheritance. The chromosomal abnormality has been identified to the...

Sudden Death Due to Granulomatous Myocarditis: A Case of Sarcoidosis?

Granulomatous myocarditis and sarcoidosis are considered uncommon entities in our local community and sudden death due to either condition has not been described in...

Gemella Empyema Cured without Antibiotics: A Case Report

Gemella are gram-positive anaerobic bacteria that rarely produce serious human infections. We describe a case of thoracic empyema that occurred in an elderly Chinese...

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 Preliminary Study of the Utility of Combined Cardiac Markers in the Evaluation of Patients Presenting Early with Suspected Acute Coronary Syndrome

The management of patients presenting with chest pain of recent onset can prove to be a diagnostic challenge. These patients vary from having atypical...

Homocysteine, Folate and Vitamin B12 as Risk Factors for Acute Myocardial Infarction in a Southeast Asian Population

Since the beginning of the last decade, hyperhomocysteinaemia has been identified as a risk factor for acute coronary syndromes. A few large prospective studies...

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...

All that Wheezes is not Asthma—Broncholithiasis, a Forgotten Disease

Asthma is a very common condition which presents clinically with cough, shortness of breath and wheezing. However, ‘all that wheezes is not asthma’, is...

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...

Myocardial Infarction in Singapore: A Nationwide 10-year Study of Multiethnic Differences in Incidence and Mortality

Rapid urbanisation and increasing affluence have improved the socioeconomic status of Asians. This, however, has brought with it new socioeconomic and medical problems resulting...

Four Pregnancies in Two Patients with Essential Thrombocythaemia—A Case Report

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

The Course of Pregnancy in a Patient with Nail-Patella Syndrome

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

Rheumatic Heart Diseases in Pregnancy

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

Case Report on Recombinant Coagulation Factor VIIa in the Treatment of Three Haemophilia A Patients with Inhibitors in Singapore

Development of inhibitors against factor VIII is one of the main complications in the treatment of haemophiliacs. Inhibitors block the procoagulant effects of factor...

Unusual Endolaryngeal Extension of a Large Thyroglossal Duct Cyst

Thyroglossal duct cysts are the most common nonodontogenic cysts that occur in the neck. They can be complicated by infections and fistulae. This article is...

Visual Rehabilitation with New-Age Rigid Gas-Permeable Scleral Contact Lenses—A Case Series

Advanced primary corneal ectasia presents a difficult problem in terms of visual rehabilitation. Soft contact lenses do not address the astigmatic aberrations in these...

Allopurinol Hypersensitivity Syndrome and Acute Myocardial Infarction—Two Case Reports

Allopurinol hypersensitivity syndrome is an idiosyncratic drug reaction characterised by an acute and severe multiorgan disease. It usually begins 2 to 6 weeks (up...

Adrenal Myelolipoma Presenting with Spontaneous Retroperitoneal Haemorrhage Demonstrated on Computed Tomography and Angiogram—A Case Report

Adrenal myelolipoma is a rare, benign tumour, usually an incidental finding. Spontaneous retroperitoneal haemorrhage resulting from this tumour is rare. This article is available only...

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...

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...

Two Case Reports on Incessant Left Ventricular Tachycardia: Curative Therapy with Radiofrequency Ablation

Left ventricular tachycardia is a recognisable condition in patients with otherwise structurally normal heart. It may arise from various foci in the left ventricle. This...

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...

Prevention of Restenosis after Percutaneous Coronary Intervention: The Continuing Challenge

Since Andreas Gruntzig first demonstrated its use in humans in 1977, the utilisation of percutaneous transluminal coronary angioplasty (PTCA) has grown tremendously throughout the...

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...

Giant Pericardial Lipoma: Unusual Cause of Intrathoracic Mass

Cardiac and pericardial lipomas are very rare tumours. They remain asymptomatic for a long time and produce symptoms, if at all, by the virtue...

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...

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...

Boerhaave’s Syndrome Presenting as a Right-sided Pleural Effusion

A 79-year-old Chinese woman with no significant past medical history was admitted to another hospital with symptoms of abdominal pain and haemetemesis of approximately...

Sweet’s Syndrome Associated with Mycobacterium chelonae and Herpes Simplex Virus Infections: A Case Report

Sweet’s syndrome is an acute febrile neutrophilic dermatosis. An association with malignancy is well recognised. This article is available only as a PDF. Please click...

A Case Series of Sotalol-induced Torsade de Pointes in Patients with Atrial Fibrillation – A Tale with a Twist

In the light of the Cardiac Arrhythmia Suppression Trial (CAST) which suggested that class I antiarrhythmics may be linked to an increase in mortality,...

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

The role of neoadjuvant chemotherapy for locally advanced breast cancer has been established and there has been a growing interest in its role in...

Intermittent Epoprostenol Infusions in Systemic Lupus Erythematosus Associated Pulmonary Hypertension—A Series of Three Cases

Pulmonary hypertension (PHT) is seen in 0.5% to 14% of systemic lupus erythematosus (SLE) patients and is associated with a grave prognosis. The overall...

Immediate and Mid-Term Safety and Efficacy of Single Lead VDD Pacemakers for Patients with Atrioventricular Block and Normal Sinus Node Function—A Single Centre Experience

In patients requiring a cardiac pacemaker for any indication, the ideal goal of therapy is to achieve atrioventricular (AV) synchrony. This replicates the normal...

Torsades de pointes in a woman presenting with syncope

A 57-year-old woman presented with first onset syncope, which was witnessed by her family members. It occurred in the middle of a conversation and...

Case Report of a Dermoid Cyst at the Floor of the Mouth

A 19-year-old Indian male with a past history of “Ludwig’s angina” was seen at the Accident and Emergency Department of National University Hospital complaining...

Difficulties in Diagnosing Lesions in the Floor of the Mouth – Report of Two Rare Cases

The floor of the mouth takes form as early as in the fourth week of gestation with the downward growth and subsequent degeneration of...

MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

Oral Pemphigus Vulgaris: A Case Report and Literature Update

Autoimmune blistering conditions are an uncommon cause of chronic ulceration of the oral mucosa. Nevertheless, it is important to diagnose these conditions early and...

Spontaneous Bone Regeneration after Mandible Resection in a Case of Ameloblastoma – A Case Report

Ameloblastoma is a true neoplasm of enamel organ type tissue which does not undergo differentiation to the point of enamel organ. This type of...

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...

A Case of Recurrent Erythema Multiforme and its Therapeutic Complications

Recurrent erythema multiforme (EM) is a disabling condition with a specific diagnosis and certain diagnostic criteria. Systemic corticosteroid therapy is frequently used to treat...

Spironolactone Does Not Prevent Restenosis After Coronary Stenting in Humans

High restenosis rate, which has been documented to occur in approximately 30% to 50% of cases, still remains a major concern, although percutaneous transluminal...

Acute Isolated Sphenoid Sinusitis

Isolated infection of the sphenoid sinus is uncommon. It usually occurs in conjunction with infection of the other paranasal sinuses. Acute isolated sphenoid sinusitis...

Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore

Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to...

A Case of a Diaphragmatic Rupture Complicated With Lacerations of Stomach and Spleen Caused by a Violent Cough Presenting With Mediastinal Shift

Diaphragmatic rupture is a recognised consequence of high-velocity blunt trauma to the abdomen and chest and also has been reported in 0% to 5%...

Initial Experience of Macular Translocation in Singapore – One-year Results

Choroidal neovascularisation (CNV) is a devastating complication of macular degeneration and a major cause of irreversible vision loss in many developed countries. The most...

The Importance of High Resolution Chromosome Analysis in the Diagnosis of Birth Defects: Case Reports of Holoproscencephaly and Cystic Hygroma

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

Cutaneous Mycobacterium haemophilum Infections in Immunocompromised Patients in a Dermatology Clinic in Singapore

Mycobacterium haemophilum is a nontuberculous mycobacterium (NTM) that is increasingly recognised as a cause of cutaneous, joint, or pulmonary infections in immunocompromised patients and...

Early Appendicitis – A Safe Diagnosis?

Appendicitis is the most common surgical condition of the abdomen. At laparotomy, an inflamed appendix is removed once it is found, and further exploration...

A Case of Nephrogenic Fibrosing Dermopathy

Nephrogenic fibrosing dermopathy (NFD) is a recently described and recognised fibrosing disorder occurring in patients with renal disease. The condition resembles scleromyxoedema clinically and...

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,...

Pulmonary Hypereosinophilia

Eosinophilic lung diseases encompass a heterogenous spectrum of lung disorders defined by increased eosinophils in blood and/or tissue. In 1952, Crofton et al proposed...

Nuclear Cardiology in Singapore: A Review

The past decade has witnessed significant advances and rapid growth in the field of nuclear cardiology. In Singapore, our experience has been similar to...

Stem Cell Cardiomyoplasty: State-of-the-Art

Congestive heart failure (CHF) remains the most common diagnosis made in cardiology wards today. At present, no long-term therapeutic option for end-stage CHF is...

Medical Therapy in Heart Failure – Is Polypharmacy Necessary?

The clinical syndrome of heart failure is recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses. Heart failure is the end-stage...

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...

Drug-eluting Stents: The End of Restenosis?

Percutaneous coronary intervention (PCI) is the preferred revascularisation approach for most patients with coronary artery disease because, with comparable clinical outcomes in selected patients,...

Coronary Artery Ectasia: A Ten-year Experience in a Tertiary Hospital in Singapore

Coronary artery ectasia (CAE) is the abnormal dilatation of a segment of the coronary artery to a diameter of at least 1.5 times that...

Pilot Survey of the Diagnosis and Management of Heart Failure in Primary Care: A Singaporean Perspective

Congestive heart failure is an increasingly common disorder and a major cause of morbidity and mortality in developed countries around the world. It is...

High-sensitivity C-reactive Protein is Predictive of Medium-term Cardiac Outcome in High-risk Asian Patients Presenting With Chest Pain Syndrome Without Myocardial Infarction

Patients with chest pain often pose a diagnostic conundrum to the attending physician especially when symptoms are not typical of angina and the electrocardiogram...

Cardiovascular Medicine and Surgery in Singapore: The Next Lap

Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial...

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...

A Case of Ductal Carcinoma In situ of Breast with Poland Syndrome

We report a rare case of multi-focal ductal carcinoma in situ (DCIS) of the breast associated with Poland syndrome. A skin-sparing mastectomy of the...

Head and Neck Cancer After Foreign Body Ingestion

Foreign bodies ingested accidentally and lodged in the upper aerodigestive tract is one of the most common emergencies seen in the Otorhinolaryngology practice in...

Dapsone Hypersensitivity Syndrome Masquerading as a Viral Exanthem: Three Cases and a Mini-Review

Dapsone hypersensitivity syndrome (DHS) is a rare condition mostly occurring in leprosy patients on multidrug therapy. Dapsone is also combined with pyrimethamine as maloprim...

A Case of Cystic Leiomyoma Mimicking an Ovarian Malignancy

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

Supernumerary Testicle in a Case of Polyorchidism

The presence of more than 2 testicles is called polyorchidism. It is a rare anomaly. This article is available only as a PDF. Please click...

An Unusual Cause of Pulmonary Haemorrhage in a Patient with Rheumatoid Arthritis

Strongyloides stercoralis is an intestinal nematode which causes a chronic but usually asymptomatic infection in humans. However, in immunocompromised patients, parasitic larvae can develop...

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...

A Rare Case of Porphyria

Porphyrias are a rare and intriguing group of metabolic disorders. We report a case of congenital erythropoietic porphyria, one of the infrequent forms of...

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

T, a 23-year-old female, was previously well until November 2000 when she presented with 1-year history of sore throat associated with neck lumps for...

Uncommon Benign Intrascrotal Tumours

Leiomyomas of the urinary tract are exceedingly rare. They can, however, arise from almost any site within the genito-urinary tract, most commonly in the...

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

A 23-year-old male patient was admitted to Ataturk Chest Disease Hospital with non-productive cough, dyspnoea, chest pain and back pain. These complaints had begun...

A Case Report of Occupational Asthma due to Gluteraldehyde Exposure

Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been...

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....

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...

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...

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...

Lymphomatoid Papulosis Associated with Recurrent Cutaneous T-Cell Lymphoma

Lymphomatoid papulosis is a self-healing recurrent popular eruption often exhibiting a chronic course. It is associated with malignant lymphomas in 10% to 20% of...

Extensive Calcinosis Cutis in Relapsed Acute Lymphoblastic Leukaemia

Calcinosis cutis is characterised by the aberrant deposition of calcium salts in the skin. In metastatic calcinosis cutis, calcium salts are precipitated in normal...

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide...

Two Case Reports of Metastases from Colon Carcinoma to the Thyroid

Metastases to the thyroid are not as rare as previously believed and have been shown, in autopsy series, to be more common than primary...

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...

Bile Duct Perforation in Children: Is it Truly Spontaneous?

Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive. This article is available only as...

Clinical Report: A Case of Williams Syndrome and Klinefelter Syndrome

Williams syndrome (WS) is a rare but well recognised neurodevelopmental disease affecting the connective tissue and the central nervous system. The syndrome was first...

Skin Manifestation of Stenotrophomonas maltophilia Infection – A Case Report and Review Article

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is found in aquatic environments. It is a frequent coloniser of fluids used in the hospital...

Unravelling the Mystery in a Case of Persistent ACTH-independent Cushing’s Syndrome

A Malaysian Chinese male patient, CMO, first presented at the age of 22 years with a 2-week history of severe spontaneous low backache with...

Neisseria meningitidis Keratitis in Adults: A Case Series

Neisseria meningitidis has been reported as a causative organism for conjunctivitis and endogenous endophthalmitis, more commonly in neonates and young children. A search of...

Presumed Dapsone-induced Drug Hypersensitivity Syndrome Causing Reversible Hypersensitivity Myocarditis and Thyrotoxicosis

A 22-year-old Malay soldier doing his National Service was warded with a 6-day history of an itchy generalised rash associated with fever and lymphadenopathy....

Visual Recovery Following Emergent Orbital Decompression in Traumatic Retrobulbar Haemorrhage

Acute retrobulbar haemorrhage is a potentially sight threatening condition that can occur spontaneously or following retrobulbar injections and trauma to the orbit. Visual loss...

16th Seah Cheng Siang Memorial Lecture – The Changing Face of Cardiology Practice, Training and Research in Singapore

Professor Seah Cheng Siang was one of the most illustrious physicians of his era. During his professional career, he held the following positions: Head,...

Recurrent Non-immune Fetal Hydrops: A Case Report

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

Recombinant Tissue Plasminogen Activator (r-TPA) in Fibrin Dissolution due to Postoperative Endophthalmitis

Cataract surgery is one of the most successful surgical procedures performed. However, postoperative endophthalmitis, defined as severe inflammation involving both the anterior and posterior...

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...

Surgically-induced Corneal Changes Following Macular Translocation with Punctate Retinotomies and Chorioscleral Infolding (Limited Macular Translocation)

Changes in corneal curvatures and astigmatism after retinal surgery are well documented. Although some of these changes are mild and transient, some have reported...

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...

A Report of Two Families with Sarcosinaemia in Hong Kong and Revisiting the Pathogenetic Potential of Hypersarcosinaemia

Sarcosinaemia (OMIN 268900) is an autosomal recessive condition due to the deficiency of sarcosine dehydrogenase (E.C. 1.5.99.1). It is a rare condition with an...

A Bolt Out of the Blue: A Case of Unexpected Acute Liver Failure

Acute hepatitis could result from viral, autoimmune or drug-reaction causes, among others. In areas endemic with hepatitis B, acute exacerbations of chronic hepatitis B...

A Hyperthyroid Patient with Measurable Thyroid-stimulating Hormone Concentration – A Trap for the Unwary

Free thyroxine (FT4), total tri-iodothyronine (T3) and thyrotropin (TSH) are the commonly measured biochemical indices in the assessment of thyroid function in a patient...

Abuse of Prescription Buprenorphine, Regulatory Controls and the Role of the Primary Physician

Buprenorphine is an opiate partial agonist that has been used for pain management, and in the past few years has been approved for the...

Neonatal Priapism Associated With Spontaneous Bilateral Pyocavernositis

Priapism is a pathological state of prolonged, generally painful erection, unassociated with sexual desire and not ending in ejaculation. Rare before the 1980s, this...

Guidelines on Cardiac CT in Singapore (2006)

The heart is difficult to image because of its complex wall motion and variability of the cardiac cycle. Recent advances in 16 and 64-slice...

Delayed Hypersensitivity Reaction After Intravenous Glucagon Administered for a Barium Enema: A Case Report

A 74-year-old Chinese woman presented with a 1-week history of an itchy rash on the trunk and legs. A barium enema was performed a...

Ethambutol-associated Optic Neuropathy

Tuberculosis (TB) has been present since ancient times. Around 460 BC, Hippocrates identified phthisis, which is the Greek term for consumption (TB seemed to...

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...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes...

Retrobulbar Alcohol Injection for Orbital Pain Relief Under Difficult Circumstances: A Case Report

The management of pain in the orbital region, whether ocular or orbital in origin, is complex and lies at the margins of several subspecialty...

Mycobacterium-related Ocular Inflammatory Disease: Diagnosis and Management

Tuberculosis (TB) is an ancient disease that has been detected in 3000-year-old Egyptian mummies. Robert Koch’s discovery of the tubercle bacillus as the aetiologic...

Intravitreal Triamcinolone Acetonide for the Treatment of Diffuse Diabetic Macular Oedema – A Case Report

Focal and grid laser photocoagulation are the primary surgical treatments for diabetic macular oedema. However, laser treatment of eyes with diffuse macular oedema has...

Potentially Fatal Paracetamol Overdose and Successful Treatment with 3 Days of Intravenous N-acetylcysteine Regime – A Case Report

Paracetamol overdose is one of the most common drug overdose in both children and adults in Singapore. Doses of paracetamol exceeding 150 mg/kg in...

Postirradiation Sarcoma of the Sphenoid Bone – A Case Report

Radiation-associated tumours of the temporal and maxillary bone have been reported in patients treated with radiotherapy for nasopharyngeal carcinoma. There was no previously reported...

Septic Monoarthritis and Osteomyelitis in an Elderly Man Following Klebsiella pneumoniae Genitourinary Infection: Case Report

Despite improved antimicrobial therapy over the past 30 years, there has been little change in the incidence, outcome, or, causative organisms in septic arthritis....

Fetus-in-fetu in the Pelvis: Report of a Case and Literature Review

Baby A was delivered at 37-week and 4-day gestation via elective caesarean section. His mother was a healthy 33- year-old with a previous uneventful...

Beyond Ortner’s Syndrome – Unusual Pulmonary Complications of the Giant Left Atrium

The giant left atrium (GLA) is a complication of severe mitral regurgitation most commonly due to rheumatic heart disease. It causes morbidity by compressing...

Dural Sinus Thrombosis after Minor Head Injury in a Child

A healthy 4-year-old Chinese girl was admitted to the hospital after a fall from a one-metre-high chair. She sustained a minor head injury to...

Periampullary Diverticulum: A Case of Bleeding from a Periampullary Diverticula

Duodenal diverticula were reported for the first time by Chomel in 1710. 1 They can be classified as either congenital or acquired and intraluminal...

Inflammatory Tumour of the Retroperitoneum – A Case Report

First diagnosed as pulmonary tumours in the adult population, inflammatory myofibroblastic tumours (IMTs) are true neoplasms that are also known to occur in children...

Swallowed Foreign Bodies in Children: Report of Four Unusual Cases

Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating...

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...

Adult-onset Re-emergent Stuttering as a Presentation of Parkinson’s Disease

A 61-year-old right-handed man with no past medical history presented to our movement disorders clinic with a history of stuttering which had begun 5...

Severe Upper Limb Complications from Parenteral Abuse of Subutex®

Subutex® (sublingual buprenorphine hydrochloride) tablets are prescribed by licensed physicians to alleviate symptoms of opiate withdrawal in addicts undergoing a cessation programme. It is...

Autosomal Dominant Familial Chronic Mucocutaneous Candidiasis Associated with Acne Rosacea

Chronic mucocutaneous candidiasis (CMC) is a rare disorder characterised by chronic and recurrent infections, predominantly caused by Candida albicans affecting the mucous membranes, nails...

Gastric Pneumatosis after Endoscopic Argon Plasma Coagulation

Argon plasma coagulation (APC) is a major haemostatic modality for large surface bleeding areas.1 It effects thermal coagulation with limited and controlled tissue depth...

Impetigo Herpetiformis – A Rare Dermatosis of Pregnancy Associated with Prenatal Complications

Impetigo herpetiformis (IH) is a rare dermatosis of pregnancy that can present dramatically in the third trimester of pregnancy with widespread cutaneous pustulosis and...

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

Postoperative surveillance for recurrence after curative colorectal cancer surgery has been enhanced with the use of F-18 fluorodeoxyglucose (FDG) combined positron emission tomography (PET)/computed...

Snakebite in a Child: Could We Avoid the Anaphylaxis or the Fasciotomies?

Snakebites have become uncommon in the metropolitan and densely populated city of Hong Kong.1-3 We recently reported a 10-year survey of snakebites in children...

A Case of Lemierre’s Syndrome Presenting with Multiple Pulmonary Abscesses Associated with a Tension Hydropneumothorax Resulting in a Mediastinal Shift

Lemierre’s syndrome (LS) is a condition which follows an oropharyngeal infection, often in an otherwise healthy young adult. This usually progresses to septic thrombophlebitis...

Post-poliomyelitis Syndrome: Case Report and Review of the Literature

Postpoliomyelitis syndrome (PPS) is characterised by the delayed appearance of new neuromuscular symptoms in patients many years after their acute poliomyelitis paralysis. PPS occurs...

Parathyroid Carcinoma: A Case Series

Parathyroid carcinomas account for 1% to 3% of patients with primary hyperparathyroidism (PHPT).1 Patients usually present with a severe form of hyperparathyroidism at diagnosis,...

Recurrent Prostatic Stromal Tumour of Uncertain Malignant Potential (STUMP) Presenting with Urinary Retention 6 Years after Transurethral Resection of Prostate (TURP)

Prostatic stromal tumour of uncertain malignant potential (STUMP) is a rare lesion, with fewer than 100 cases reported worldwide. It is considered a neoplastic...

Fungal Pan-sinusitis with Severe Visual Loss in Uncontrolled Diabetes

Fungi are known opportunistic organisms, which potentially invade and infect a host with depressed immunity. Fungal pan-sinusitis complicated with orbital apex syndrome or cavernous...

The Association of Smoking with Components of the Metabolic Syndrome in Non-diabetic Patients

Metabolic syndrome (MS) is conceptualised as a constellation of physiologic or anthropometric abnormalities. Typically, it includes excess weight, hyperglycaemia, elevated blood pressure, low concentration...

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

Coronary artery disease (CAD), also called coronary heart disease, is the leading cause of death for both men and women. CAD is usually caused...

Metastasis to the Sinonasal Tract from Sigmoid Colon Adenocarcinoma

A 52-year-old female was diagnosed with well-differentiated adenocarcinoma of the sigmoid colon in 1999. An anterior resection was performed followed by adjuvant chemotherapy for...

An Unusual Presentation of a Giant Frontal Sinus Mucocele Manifesting with a Subcutaneous Forehead Mass

A mucocele is an epithelium-lined mucus-containing sac which usually develops when the ostium of a paranasal sinus becomes obstructed by chronic sinusitis, polyps or...

Cavitating Cryptococcal Pneumonia in the Immunocompetent Host

Three immunocompetent male patients with cryptococcal pneumonia presented to our hospital between June 2000 and November 2001. They had varied presentations, as shown in...

Cyclosporin-induced Sebaceous Hyperplasia in Renal Transplant Patients

There are several reports in the literature of sebaceous hyperplasia being induced by cyclosporin in immuno-suppression of organ transplant patients. The condition was only...

Artificial Urinary Sphincter in Adult Male with Neurogenic Stress Urinary Incontinence: A Rare Indication

The artificial urinary sphincter (AUS) is an established modality for the management of stress urinary incontinence. It is usually used in adults with post-radical...

First Branchial Cleft Anomalies have Relevance in Otology and More

The external ear canal is a derivative of the first branchial cleft. Anomalies of the first branchial cleft, therefore, often involve external ear canal...

An Unusual Case of an Intramuscular Lipoma of the Pectoralis Major Muscle Simulating a Malignant Breast Mass

Intramuscular lipomas of the pectoralis major muscle are rare tumours.1 We describe an unusual case of a lipoma of the pectoralis major muscle which...

Development of Ipsilateral Adrenocortical Carcinoma Sixteen Years after Resection of an Adrenal Tumour Causing Cushing’s Syndrome

Adrenocortical carcinoma is a rare tumour, with an annual incidence of 0.5 to 2 per 1 million people. The overall 5-year survival rate ranges...

Legal Issues in the Treatment of a Violent Manic Patient in a Non-Gazetted Setting: A Case Report

Mr X, a 68-year-old Indian, was the chairman of a big corporation. He had had a history of bipolar disorder for the past 40...

Rapid Cystic Development in Relation With an Impacted Lower Third Molar: A Case Report

There are many conditions affecting the jaws that present with a cystic, radiographic appearance. Odontogenic cysts and tumours have the potential to reach considerable...

Caesarean Scar Pregnancy: A Diagnosis to Consider Carefully in Patients with Risk Factors

A uterine scar pregnancy is a gestation separated from the endometrial cavity and completely surrounded by the myometrium and the fibrous tissue of the...

Tuberculosis Post-Liver Transplantation: A Rare but Complicated Disease

Tuberculosis (TB) is a serious opportunistic infection in transplant recipients, with an incidence in organ transplant recipients ranging from 0.35% in developed countries to...

Vision Restoration Therapy: New Hope for Stroke Patients with Visual Field Loss

Patients suffering from visual field defects caused by optic nerve or post-chiasmatic injury commonly experience many limitations in their daily activities. The generally accepted...

Placental Calcification in Pseudoxanthoma Elasticum

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

Effects on the Contralateral Eye After Intravitreal Bevacizumab and Ranibizumab Injections: A Case Report

Vascular endothelial growth factor (VEGF) is recognised as an important mediator in the pathogenesis of age-related macular degeneration (AMD) and retinal neovascularisation. Anti-VEGF therapies...

Concomitant Coronary Artery Disease Among Asian Ischaemic Stroke Patients

Coronary artery disease (CAD) is the leading cause of mortality following ischaemic stroke. The annual risk for myocardial infarction following ischaemic stroke is approximately...

Improving Door-to-balloon Times in Primary Percutaneous Coronary Intervention for Acute ST-elevation Myocardial Infarction: The Value of an Audit-driven Quality Initiative

Primary percutaneous coronary intervention (PCI) for patients with acute ST-elevation myocardial infarction (STEMI) has been shown to be superior to thrombolytic therapy in terms...

Risk Factor Profile and Treatment Patterns of Patients with Atherothrombosis in Singapore: Insight from the REACH Registry

Atherothrombosis is a global problem that affects every ethnic group. It can lead to ischemic stroke, myocardial infarction or vascular death. This article is available...

Non-compaction Cardiomyopathy Presenting with Classical Angina Pectoris

Non-compaction cardiomyopathy (NCC) is an unclassified cardiomyopathy, previously known as “spongy left ventricular myocardium”. It is characterised by prominent myocardial trabeculations and deep intertrabecular...

A Case of Myopericarditis in a Patient with Methicillin-resistant Staphylococcus aureus Community-acquired Pneumonia

We described a healthy and physically active 41-year-old man who presented to a private practitioner with right axillary pain and fever. Physical examination revealed...

Pathological Pulmonary Hernia in a Patient With Metastatic Breast Cancer

Pulmonary hernia is a rare and uncommon clinical entity that has been defined as a protrusion of pleural membranes or lung parenchyma through the...

Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation

Scorpion stings represent an important and serious public health problem worldwide due to their high incidence and potentially severe and often fatal clinical manifestations,...

The Relation Between Insulin Resistance Determined by Haemostatic Modelling and Slow Coronary Flow

Slow coronary flow (SCF) is a well recognised clinical entity, characterised by delayed opacification of coronary arteries in the presence of normal coronary angiogram....

Improving Access to Outpatient Cardiac Care at the National Heart Centre – A Partnership Between Specialists and Primary Care

There is evidence that shows that the use of healthcare delivered by private providers, particularly procedures and hospital care, depends on supply. For example,...

Pattern and Outcome of Subsidised Referrals to Cardiology Specialist Outpatient Clinics

Singapore faces an increasing demand for public healthcare from an ageing population in need of chronic care. At our cardiology specialist outpatient clinics, the...

Phaeochromocytoma the Great Mimicker: A Case Report

Phaeochromocytomas are catecholamine producing neuroendocrine tumours that can manifest a variety of symptoms which mimic other diseases. They are also known for their “rule...

Thoracic Complications of Radiofrequency Ablation of Recurrent Hepatoma

Radiofrequency ablation (RFA) intended to produce complete thermal necrosis of unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the...

An Unexpected Presentation of Endometriosis – A “Parasitic” Cyst of the Bowel in a Menopausal Woman on Hormone Therapy

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

The Angiographic Aspects of Myocardial Bridges in Turkish Patients who have Undergone Coronary Angiography

Myocardial bridge, intramural coronary artery, coronary artery over bridging and myocardial loop are essentially the different terms used to designate the same phenomenon. Myocardial...

Suprascapular Nerve Neuropathy Secondary to Spinoglenoid Notch Ganglion Cyst: Case Reports and Review of Literature

Shoulder pain and dysfunction have long been the bane of both the young and old alike. Common causes include local conditions such as rotator...

A Case Report of Endovascular Stenting in Salmonella Mycotic Aneurysm: A Successful Procedure in an Immunocompromised Patient

Mycotic aortic aneurysm carries a high mortality and morbidity rate. Traditionally, such cases are treated with open surgery, including extra-anatomical or in-situ graft repair....

Managing Breast Cancer Diagnosed in First Trimester Pregnancy: A Case Report

Cancer complicates approximately 1 per 1000 pregnancies and accounts for one third of maternal deaths during gestation.1,2 The reproductive system is affected by malignant...

Tetanus in an Injecting Buprenorphine Abuser

Problems with parenteral drug abuse with opioids and infectious complications have been well-described in medical literature.1-3 Substitution drugs such as buprenorphine (Subutex) have been...

EUS-FNA of the Left Adrenal Gland is Safe and Useful

The occurrence of an adrenal mass in patients with an underlying malignancy may represent distant metastases, precluding curative surgical resection of the primary malignancy....

Late Complications Following Tetralogy of Fallot Repair: The Need for Long-term Follow-Up

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease with an incidence of approximately 0.5/1000 live births (5% to 7% of...

Clear Cell Carcinoma of Minor Salivary Gland – Case Report

Clear cell carcinoma is a rare low-grade carcinoma that occurs almost exclusively in the intra-oral minor salivary glands.1-11 Occasional cases have been reported in...

Peripartum Acute Anterior ST Segment Elevation Myocardial Infarction: An Uncommon Presentation of Acute Aortic Dissection

Reperfusion therapy in the form of primary angioplasty or thrombolytic therapy is the cornerstone of management in patients presenting with acute ST segment elevation...

Arteriovenous Fistula Aneurysm – Plicate, Not Ligate

Arteriovenous fistulae (AVF) are created for haemodialysis in patients with end-stage renal failure. While AVF is a lifeline for these patients, its creation is...

Cluster of Staphylococcus aureus and Dengue Co-infection in Singapore

In recent years, Singapore has seen a resurgence of dengue fever despite the seemingly successful implementation of a nationwide Aedes mosquito control programme,1 culminating...

Neurogenic Pulmonary Oedema Misdiagnosed as Acute Myocardial Infarction in a Comatose Patient

Neurogenic pulmonary oedema (NPO) is a well recognised complication of subarachnoid haemorrhage (SAH) and severe traumatic brain injuries (TBI).1 The incidence of NPO was...

Avoiding Dialysis in Tumour Lysis Syndrome: Is Urate Oxidase Effective? – A Case Report and Review of Literature

Tumour lysis syndrome (TLS) is frequently associated with lymphoproliferative malignancies. It is the result of massive spontaneous or chemotherapy-induced cytolysis, leading to the release...

POEMS Syndrome – A Case for More Aggressive Treatment

POEMS syndrome is a rare, multisystem disorder originally characterised by the presence of polyneuropathy, organomegaly, endocrinopathy, monoclonal or M-protein and skin changes. Bardwick proposed...

Case Report: Induction of Immune Tolerance to Factor VIII Inhibitor after a Major Operation

Mr ZBH was a 30-year-old man with a history of severe haemophilia A with 0% factor VIII (FVIII). He was initially supported with cryoprecipitate...

Ovarian Carcinoma Presenting With Isolated Contralateral Inguinal Lymph Node Metastasis: A Case Report

Ovarian carcinoma is the most frequent cause of death from gynaecological malignancies in the United States. Rates for ovarian carcinoma in Singapore fall between...

Thalidomide-associated Arterial Thrombosis: Two Case Reports

Thalidomide was used as a sedative in the 1950s and was withdrawn from the market after initial reports of teratogenicity in 1961. In 1998,...

Lessons Learnt from Two Women with Morbidly Adherent Placentas and a Review of Literature

Pathologically adherent placenta occurs when there is a defect of the decidua basalis, resulting in abnormally invasive implantation of the placenta into the substance...

Pars Plana Vitrectomy and Internal Limiting Membrane Peeling for Macular Oedema Secondary to Retinal Vein Occlusion: a Pilot Study

Macular oedema is a major cause of visual impairment in a number of ocular conditions such as diabetic retinopathy, retinal vein occlusion, Irvine-Gass syndrome...

Is There a Place for Placebo in Management of Psychogenic Movement Disorders?

The term “placebo” is derived from St Jerome’s Latin Psalm, placebo domino in regione vivorum (I shall please the Lord in the land of...

A New Method for the Removal of Safety Pins Ingested by Children

Foreign body ingestion is a relatively common problem, with an estimated incidence of 120 per 1 million population, resulting in approximately 1500 deaths each...

Paradoxical Orthodeoxia in a Patient with a Large Thoracic Aortic Aneurysm

We report an unusual case of “paradoxical orthodeoxia” in a man with a large asymptomatic thoracic aneurysm of the ascending aorta, arch and proximal...

Case Reports of Transient Loss of Vision and Systemic Lupus Erythematosus

In 1999, the American College of Rheumatology (ACR) research committee defined 19 specific neuropsychiatric systemic lupus erythematosus (SLE) syndromes to achieve a consensus in...

Angioedema and Systemic Lupus Erythematosus – A Complementary Association?

Systemic lupus erythematosus (SLE) is an autoimmune multi-system disease of unknown aetiology with protean clinical and laboratory manifestations and a variable course and prognosis....

Symphysis Pubis Diastasis After Normal Vaginal Birth: A Case Report

The reported incidence of symphysis pubis diastasis following vaginal delivery is very low. The injury is more commonly caused by severe trauma from road...

Successful Rehabilitation With Cochlear Implant in Post-irradiation Induced Hearing Loss in Nasopharyngeal Carcinoma Patient

Nasopharyngeal carcinoma (NPC) is a common disease in Asia.1 Radiotherapy is the mainstay of treatment. Following radiotherapy, complications like profound sensorineural hearing loss may...

Emphysematous Gastritis: A Case Report and a Review of Literature

A 45-year-old Chinese lady, who is a known hepatitis B carrier, presented with increasing alpha fetoprotein levels and a palpable liver 6 cm below...

Efficacy of Limited-Duration Spinal Cord Stimulation for Subacute Postherpetic Neuralgia

Peripheral and central sensitisation of the nervous system through prolonged pain is commonly believed to be a mechanism responsible for facilitating the development of...

Metastatic Bladder Cancer Presenting as Duodenal Obstruction

Bladder cancer is the most common malignancy of the urinary tract. Peak incidence is in the 6th and 7th decades although recent trends have...

Successful Preimplantation Genetic Diagnosis of Hb Bart’s Hydrops Fetalis in Singapore after Fresh and Frozen Embryo Replacement Cycles

Alpha-thalassaemia is one of the most common genetic disorders worldwide. It results from absent or reduced production of a-globin chains caused by mutations in...

Food-dependent Exercise-induced Anaphylaxis – A Review of 5 Cases

Anaphylaxis is a severe, potentially fatal, systemic reaction that occurs suddenly after contact with an allergy-causing substance, typically involving 2 or more systems: skin/mucosal,...

Imaging Findings of Chronic Subluxation of the Os Odontoideum and Cervical Myelopathy in a Child with Beare-Stevenson Cutis Gyrata Syndrome after Surgery to the Head and Neck

Fractures of the odontoid typically involve the synchondrosis between the odontoid process and body of the axis in the paediatric age group. However, to...

Residual Neurovascular Function and Retinotopy in a Case of Hemianopia

Homonymous hemianopia is one of the most common forms of acquired visual field defects.1 It is typically produced by head injury, tumours or stroke...

Management of Acute ST-Elevation Myocardial Infarction: Reperfusion Options

Cardiovascular disease is a leading cause of death globally. More than 920,000 myocardial infarctions (MI) are diagnosed annually in the United States. Of these,...

A Case of Acute Myocardial Infarction 24 hours after Acute Ischaemic Stroke

It is well known that thrombolysis for acute myocardial infarction (AMI) may lead to disintegration of pre-existing intracardiac thrombi with subsequent cerebral embolisation. It...

Primary Lymphoedema at an Unusual Location Triggered by Nephrotic Syndrome

Lymphatic system returns proteins, lipids and accompanying water from the interstitium to the venous circulation near the subclavian vein-internal jugular vein junction, bilaterally. Lymphoedema...

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

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

The Growing Burden of Cardiovascular Disease: Role of the Arterial-Cardiac Interaction

World Heart Day was inaugurated to increase global awareness that cardiovascular disease (CVD) is the world’s leading cause of death, claiming, according to the...

Comparison of Cardiac Output Measurement by Arterial Waveform Analysis and Pulmonary Artery Catheter in Mitral Stenosis

Cardiac output (CO) is a vital measurement that influences clinical decision-making. Although thermodilution via a pulmonary artery catheter (PAC) is considered the gold standard...

Live or Let Die: Ethical Issues in a Psychiatric Patient with End-stage Renal Failure

Ms T was a single, 41-year-old Chinese female who had been diagnosed with schizoaffective disorder at the age of 21. Her illness was characterised...

Unusual Pacemaker Lead Placement in an Unsuspecting Heart

A 51-year-old man, with a negative cardiac medical history, presented with symptomatic 2:1 atrioventricular block. A permanent pacemaker was implanted. This article is available only...

Embolised Injection Needle Fragment to the Heart, Mimicking a Subcutaneous Charm Needle

Embolisation of a fragmented injection needle to the heart is rare, even in intravenous drug abusers. The presence of an embolised needle fragment to...

Inflammatory Tinea Capitis: Non-healing Plaque on the Occiput of a 4-year-old Child

Tinea capitis is a fungal infection of the hairs of the scalp. Although commonly described in children, it is uncommonly seen in Singapore. This article...

Transcatheter Closure of Atrial Septal Defects – Is Balloon Sizing Still Necessary?

Device closure of atrial septal defects through the transcatheter approach has now been well accepted as an option to surgical treatment. A range of...

Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients

The term “stroke” comprises all diseases in which a region of the brain is transiently or continuously affected by ischaemia or haemorrhage, and/or in...

Eighteen-Month Clinical Safety and Efficacy Outcomes of Sirolimus-, Paclitaxel- and Zotarolimus-drug Eluting Stents in Diabetic Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Artery Stenosis

Patients with diabetes mellitus (DM) have higher incidence of cardiovascular morbidity and mortality compared with non-diabetic patients. The underlying mechanism is due to the...

Risk Factors and Clinical Outcomes for Contrast-induced Nephropathy After Percutaneous Coronary Intervention in Patients with Normal Serum Creatinine

Contrast-induced nephropathy (CIN) is a common complication post-percutaneous coronary intervention (PCI). CINis associated with increased morbidity, mortality, prolonged hospitalisation and long-term renal impairment. This article...

Brachial Approach for Coronary Angiography and Intervention: Totally Obsolete, or a Feasible Alternative When Radial Access is Not Possible?

The possible methods of reaching the coronary vasculature using a percutaneous technique are limitless: the radial, femoral, brachial, ulnar, subclavian and axillary arteries, and...

Angioplasty on an Infarct-related Anomalous Right Coronary Artery Arising from Posterior Coronary Sinus

A 60-year-old chronic smoker had delayed presentation (>18 hours) of acute inferior myocardial infarction with electrocardiogram showing 1.0 mm ST-segment elevation in leads II,...

Complete Atrioventricular Block Complicating Acute Anterior Myocardial Infarction can be Reversed with Acute Coronary Angioplasty

Complete atrioventricular block (AVB) develops in more than 5% of patients with myocardial infarction (MI). These patients have poorer outcomes compared to those without...

Acute Myocardial Infarction in Pregnant Women

Acute myocardial infarction (AMI) is an important cause of mortality and morbidity worldwide. It typically occurs in middle-aged or elderly people with cardiovascular risk...

Risk Stratification for Sudden Cardiac Death after Acute Myocardial Infarction

In today’s modern era of evidence-based medicine and interventional cardiology, most patients who suffer an acute myocardial infarction (AMI) are started on medication with...

Adjunctive Pharmacologic Agents and Mechanical Devices in Primary Percutaneous Coronary Intervention

Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI), with...

Management of Antiplatelet Therapy During Acute Percutaneous Coronary Intervention: New Strategies and Therapeutics

Platelet adhesion, activation, and aggregation are stimulated during an acute coronary syndrome (ACS), the result of intimal injury due to rupture of an atherosclerotic...

Risk Assessment Models in Acute Coronary Syndromes and Their Applicability in Singapore

Strategies for managing cardiovascular disease are evolving rapidly. This evolution and improvement in care is responsible for reducing mortality especially in patients presenting with...

Current Trends in Diagnostic Biomarkers of Acute Coronary Syndrome

Advances in our understanding of the pathophysiology of acute coronary syndrome (ACS) have led to the marked increase in development of biomarkers for diagnosis,...

Update on Clinical Imaging of Coronary Plaque in Acute Coronary Syndrome

Acute coronary syndrome (ACS) encompasses the clinical spectrum of unstable angina (UA) and acute myocardial infarction (AMI). Most ACS are precipitated by luminal thrombi...

Panic Attack and its Correlation with Acute Coronary Syndrome – More Than Just a Diagnosis of Exclusion

Acute coronary syndrome (ACS) is a life-threatening condition which benefits from prompt evaluation and proper treatment, such that it would be considered negligent for...

Research on Psychoneuroimmunology: Does Stress Influence Immunity and Cause Coronary Artery Disease?

In recent decades, there has been increasing interest in exploring the relationship between psychological stress and various health conditions. An enlarging body of evidence...

Clinical and Angiographic Findings of Complete Atrioventricular Block in Acute Inferior Myocardial Infarction

Complete atrioventricular block (AVB) complicates inferior wall myocardial infarction (MI) in 11% to 15% of cases. It usually clusters with conditions indicative of poor...

Reperfusion Strategy and Mortality in ST-Elevation Myocardial Infarction among Patients with and without Impaired Renal Function

Randomised controlled trials have demonstrated better outcomes with primary percutaneous coronary intervention (PCI) over fi brinolytic therapy in the treatment of ST-segment elevation myocardial...

Gender Disparity in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndromes – Does it Still Exist in Contemporary Practice?

Globally, cardiovascular disease (CVD) is the single most common cause of death among women; and in parallel with an increasing life expectancy, the proportion...

The Impact of Gender on the Outcomes of Invasive versus Conservative Management of Patients with Non-ST-Segment Elevation Myocardial Infarction

Recent studies have suggested differences in clinical outcomes between men and women following acute myocardial infarction (AMI). Some studies have indicated poorer survival of...

Cardiac Rupture due to Fall: A Case Study

Studies have shown that cardiac ruptures due to blunt trauma are seen more often than expected. Isolated left ventricular injuries tend to be less...

Framingham Risk Score Inadequately Predicts Cardiac Risk in Young Patients Presenting with a First Myocardial Infarction

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. The Framingham Risk Score (FRS) was derived from the Framingham Heart Study...

Acute Coronary Syndrome: from Epidemiology to Treatment

The term “acute coronary syndrome” (ACS) was introduced a decade ago to describe a spectrum of conditions resulting in acute myocardial ischaemia. It comprises...

Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report

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

Off-Pump versus On-Pump Coronary Artery Bypass Procedures: Postoperative Renal Complications in an Asian Population

To date, the major part of routine cardiac surgery is performed using extracorporeal circulation with cardioplegic arrest. Regardless the technique of cardioplegia, temporary renal...

A Unique Pair of Monozygotic Twins with Concordant Clear Cell Renal Cell Carcinoma: A Case Report

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

Radiological Outcome of Short Segment Posterior Stabilisation and Fusion in Thoracolumbar Spine Acute Fracture

The management of unstable thoracolumbar spine fractures remains controversial in spite of an improved knowledge of the morphometric, anatomic and biomechanical features of thoracolumbar...

Surgical Remodelling of Haemodialysis Fistula Aneurysms

The Kidney Disease Outcomes Quality Initiative (DOQI) guideline 3 recommends autogenous radiocephalic and brachiocephalic arteriovenous fistula (AVF) as the first and second choices of...

Managing a Case of Extensively Drug-Resistant (XDR) Pulmonary Tuberculosis in Singapore

Extensively drug-resistant tuberculosis (XDR-TB) is defined as TB which is resistant not only to the 2 best first-line anti-TB medications, rifampicin and isoniazid (known...

Catheter Entrapment During Cardiac Electrophysiology Study

A 50-year-old man underwent cardiac electrophysiology study for palpitations. Under fluoroscopic guidance, 1 deflectable decapolar and 2 quadripolar diagnostic catheters were introduced smoothly into the...

Treatment of Coronary In-stent Restenosis with Drug-eluting Balloon Catheter: Real-world Outcome and Literature Review

Dear Editor, Currently, coronary stent implantation is employed in approximately 90% of percutaneous coronary intervention (PCI) cases. Despite the use of drug-eluting stents (DES), coronary...

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...

Long-term Outcomes of Medical Therapy Versus Coronary Revascularisation in Patients with Intermediate Stenoses Guided by Pressure Wire

Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram...

Chest Pain, Something is Not Right…Or Left

A 46-year-old female was referred for evaluation of central chest pain unrelated to exertion. She was known to have diabetes mellitus, hypertension, and dyslipidaemia....

A Novel “Box Lesion” Minimally Invasive Totally Thoracoscopic Surgical Ablation for Atrial Fibrillation

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of...

Improved door-to-balloon time for primary percutaneous coronary intervention for patients conveyed via emergency ambulance service

Early reperfusion of ST-segment elevation myocardial infarction (STEMI) has been shown to result in better outcomes,1-3 and guidelines for treatment of STEMI recommend a...

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...

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....

ST-segment elevation myocardial infarction in post-COVID-19 patients: A case series

Coronavirus disease 2019 (COVID-19) has been associated with thromboembolic phenomenon in the early phase of disease. Growing evidence suggests a hypercoagulable state as well...

Medical management of PAD: Expand or consolidate?

In this issue of the Annals, a rapid review of adherence to evidence-based medical treatment highlights an important and underappreciated aspect of the management...

Dynamic mitral regurgitation treated with MitraClip

The dynamic nature of mitral regurgitation (MR) has been well appreciated but clinically under-recognised. In addition, evidence on therapeutic options for dynamic MR has...

Percutaneous paravalvular leak repair for severe aortic regurgitation after transcatheter aortic valve implantation (TAVI)

Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous...

Impact of dispatcher-assisted cardiopulmonary resuscitation and myResponder mobile app on bystander resuscitation

Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with a global incidence of 62 cases per 100,000 person-years. In addition, there...

Cerebral venous thrombosis in a patient with mild COVID-19 infection

Emerging reports suggest venous and arterial thromboembolic diseases can complicate recovery from COVID-19. Postulated mechanisms include hypercoagulability, hypoxia, immobilisation, excessive inflammation and diffuse intravascular...