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

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

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

Synder in 1932 wrote the first report on the Mendelian inheritance of the inability to taste phenylthiourea. Twenty-five years later, Arno Motulsky suggested hereditary factors might be the explanation to inter-individual differences in drug responses. This article is available only as a PDF. Please click on “Download PDF” on top...

Physicians have long accepted unreliable evaluations of the risks attached to pharmacotherapy, i.e. treating our patients with drugs. The reasons for the uncritical attitude towards medication, which comprise 60% to 90% of all clinical interventions, depending on specialty, have not been systematically studied. This article is available only as a...

Evaluating new drugs for marketing approval is a highly specialised and knowledge-intensive activity. This is especially so if the intention is to conduct quality, safety and clinical evaluations of new drugs that have not been approved elsewhere. This article is available only as a PDF. Please click on “Download PDF”...

Informal review and synthesis of scientific evidence has been practised for as long as experiments have been replicated. The idea of quantitatively combining the evidence from different samples can be traced back to the early 1900s, when Karl Pearson analysed the preventive effect of serum inoculations against enteric fever. This...

A “megatrial” is a very large randomised controlled clinical trial (RCT) recruiting many thousands of patients from many centres in order to assess the effectiveness of treatments on clinical outcomes. Examples of megatrials which successfully recruited more than 10,000 patients include the International Studies of Infarct Survival (ISIS) series...

There has been a rapid increase in clinical trial activity in Singapore and other parts of Asia. Randomised clinical trials are the “gold standard” in study design, which enable the question of efficacy of different treatments or managements to be effectively compared. This article is available only as a PDF....

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

Clinical pharmacology (CP) as a discipline comes in many guises. The perception for a medical student, and for many doctors, may be that of a painful series of lists of drugs to learn, the drugs being traditionally classified by functionality and effects. This article is available only as a PDF....

In clinical trials, subjects are usually entered one at a time, and their responses to treatment monitored sequentially. Regular monitoring of trial progress during the early stages is advisable, and prompt attention to data errors, inconsistencies or missing items on the case record forms (CRFs) is required, so that...

The pathway by which patients enter clinical trials can be a selective, non-random process. In order for patients to enter clinical trials, a set of circumstances must occur exclusive of having the disease being investigated and meeting clinical entry criteria. This article is available only as a PDF. Please click...

Traditional designs for clinical trials make balanced (or 50-50) allocation of patients to treatments. This is done in the past to minimise the variance of different estimators. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

There is general consensus that randomised clinical trial (RCT) can provide the most valid conclusions about effects of different treatment as eligible patients are randomly allocated into two or more alternative treatments. Trials using non-randomised comparison groups like historical controls tend to yield more optimistic results than randomised trials. This...

Placebo-trials on HIV-infected pregnant women in developing countries like Thailand and Uganda have provoked recent controversy. Such experiments aim to find a treatment that will cut the rate of vertical transmission more efficiently than existing ‘gold standard’ treatments like zidovudine. This article is available only as a PDF. Please click...

Are medicines dangerous chemicals or life enhancing agents? The answer is ‘Both of those things, often at the same time, and worse in the wrong hands’. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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

Multiple myeloma (MM) is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or IgA. The incidence of MM in Singapore is 1 to 2 per 100,000 per year with a median age of 65 to 70 years at...

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

Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The most commonly diagnosed malignancies during pregnancy are breast cancer, cervical carcinoma, Hodgkin’s lymphoma and melanoma. This article is available only as a PDF. Please click on...

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

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

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

Rising rates of antibiotic resistance prompted a review of antibiotic use policies hospitalwide. The Department of Haematology established a new set of consensus guidelines in 2002 for antibiotic use in febrile neutropenia. We were tasked by the hospital’s Pharmacy and Therapeutics Committee to audit adherence to the guidelines. This article...

Multidisciplinary care has now been established as the optimal management principle for the majority of malignancies.1,2 However, the model of multidisciplinary care, specifically the role of a formal multidisciplinary tumour clinic (MTC), remains unestablished outside of breast cancer care.2 There is minimal evidence to quantitatively assess the potential benefits...

Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been increasing. Since 1982, malignant cancers have been the leading cause of death in Taiwan. This article is available only as a PDF. Please click on “Download...

Dear Editor, Ewing sarcoma is a malignant mesenchymal tumour that presents as a bone or soft-tissue sarcoma. Translocations involving the EWS gene on chromosome 22q12 are unique molecular signatures.1,2 Compared with the West where the annual incidence is 1–3 per million, incidence has been reported to be lower among Asians1...