Original Article
Clinical utility of PET/MRI in multiple myeloma
Multiple myeloma (MM) is a haematological malignancy characterised by abnormal accumulation of malignant plasma cells and is associated with anaemia, renal impairment, hypercalcemia and bone lesions. A sensitive method to detect bone lesions is crucial as it could determine the decision to start treatment. In this era, the International...
Commentary
Transforming radiology to support population health
The recent launch of Healthier SG—a national initiative by Singapore’s Ministry of Health (MOH) focusing on preventive health—will have far-reaching effects on the delivery of health services in Singapore.1 Part of it involves a shift away from tertiary hospital-based to community-based care, to improve diagnostic imaging services in the...
Editorial
Self-esteem and positive body image to overcome female sexual dysfunction
Human sexuality is arguably one of the main pillars of health, like nutrition and sleep. Improvements in diagnostic and therapeutic biotechnologies have enabled focus on not only deadly diseases, but also on the quality of life and sexual functions of men and women. Digital media also play a considerable...
Original Article
Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging
Allergic and non-allergic hypersensitivity reactions to iodinated contrast media (ICM) are increasingly recognised, particularly the latter where there is greater clarity on pathomechanisms.1 There is limited evidence for the use of corticosteroids as premedication to prevent the occurrence of contrast-related reactions. At our institution, a dose of 30mg oral...
Editorial
Preventing recurrent hypersensitivity reactions to iodinated contrast media
Iodinated contrast media (ICM) is one of the most commonly used drugs in the practice of modern medicine. ICM, as the name implies, is a contrast media that contains iodine. It is frequently used in computed tomography (CT) and angiographic procedures, to highlight important anatomical structures and for the...
Editorial
Challenges with mainstreaming genetic testing for metastatic prostate cancer treatment in Singapore
Compared with other solid tumours, patients with metastatic prostate cancer typically have better survival in the range of years.1 The long survival translates to a high prevalence, and thus, a large number of men living with prostate cancer. Singapore has one of the highest age-standardised incidence rates of prostate...
Letter to the Editor
Erdheim-Chester disease: Imaging spectrum of multisystemic manifestations
Dear Editor,
Erdheim-Chester disease (ECD) is a rare non-Langerhans histiocytosis, usually affecting middle-aged to older adults. It is a multisystemic disease with protean clinical manifestations. It can involve single or multiple organs, and presentations range from asymptomatic lesions detected incidentally on imaging to severe organ dysfunction. Hence, accurate and timely...
Letter to the Editor
Implementation of an AI model to triage paediatric brain magnetic resonance imaging orders
Dear Editor,
Artificial intelligence (AI) is viewed as the most important recent advancement in radiology with the potential to achieve Singapore’s objective of delivering value-based patient-centric care.1
We have developed and implemented a deep-learning model using bidirectional long short-term memory (Bi-LSTM) neural network to enable automated triage of unstructured free-text...
Commentary
Low-dose computerised tomography screening for lung cancer in Singapore: Practical challenges of identifying participants
INTRODUCTION
In March 2022, the European Commission on cancer screening suggested the inclusion of low-dose computerised tomography (LDCT) for lung cancer, targeted at current and former smokers.1 The aim of LDCT screening is to increase early detection, decrease diagnoses at metastatic stage of the disease and improve overall 5-year...
Images in Medicine
TB or not TB? The axillary lump question
An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule with a central keratinous plug in the right axilla (Fig. 1). The surrounding skin was pigmented, non-tender and indurated. Sonography of the nodule demonstrated an...
Letter to the Editor
Safe time interval for screening estimated glomerular filtration rate prior to gadolinium-enhanced MRI scan
Dear Editor,
Magnetic resonance imaging (MRI) contrast media are commonly used in medical imaging and are usually gadolinium-based contrast agents (GBCAs). They can be divided into 3 groups. Group I consists of compounds with linear molecular structures. Group II consists of compounds with macrocyclic molecular structures. Group III currently includes...
Commentary
The Lancet Commission on diagnostics: What it means for Singapore
Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and global disparity regarding this healthcare value chain has been one of the fundamental problems with prioritised urgency since the United Nation’s Millennium Development Goals were...
Others
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 or absence of lining epithelium.
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Others
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 on heparin therapy for several days may exhibit resistance to heparin given before cardiopulmonary bypass.
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Others
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 gravis (MG) on steroid therapy and non-insulin dependent diabetes mellitus (NIDDM) who developed cryptococcal meningitis and in whom a search for a persistent focus by...
Others
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 limited and runs a chronic, benign course.
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Others
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 earlier progressing to generalised eczema 5 months prior to consultation. He was diagnosed to have generalised exfoliative dermatitis (GED).
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Others
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.
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Others
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 many factors which may affect the accuracy of this technique such as the volume, temperature and timing of the injectate.
This article is available only as...
Others
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 slowing in the background with stereotypical generalised periodic high-voltage slow and sharp wave complexes.
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Others
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 anaesthesia by the cardiothoracic surgeon has remained the procedure of choice for FB removal in the airways, failing which thoracotomy and bronchotomy is performed.
This article...
Original Article
Reduction in Retake Rates and Radiation Dosage Through Computed Radiography
New computed radiography imaging systems are slowly gaining a foothold in radiological departments worldwide. By computed radiography we mean a digital imaging system which exposes a photostimulable phosphor image receptor plate to obtain a latent image using existing radiographic equipment.
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Original Article
Computed Tomographic and Magnetic Resonance Imaging Findings in Paranasal Sinus Involvement in Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma (NPC) is an aggressive infiltrative neoplasm. Spread into the paranasal sinuses is often seen but the frequency is documented in only a few series.
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Others
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.
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Others
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.
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Others
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 menses and a pelvic mass on an abdominal ultrasound arranged by her General Practitioner (GP). She was otherwise asymptomatic.
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Others
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%.
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Others
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.
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Original Article
Outcome of Obstructive Uropathy After Pelvic Irradiation in Patients with Carcinoma of the Uterine Cervix
Radiotherapy is the mainstay treatment for locally advanced carcinoma of the cervix. It is also administered as an adjuvant therapy to patients deemed at high risk for local recurrence after radical hysterectomy.
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Letter to the Editor
Re: Haematuria in the Diagnosis of Urinary Calculi. SBS Ooi, NW Kour, A Mahadev. Ann Acad Med Singapore 1998; 27:210-4
The above article highlights the insensitivity of urine microscopy compared with the Combur 9 test for detecting haematuria associated with urinary calculi. In the article, the equivalent microscopic RBC values for the Combur 9 are given as 5/ml (typo? it should be 5/µl) and 10 /ml (?10/µl) for intact...
Others
Book Review
This book is a collection of 30 case studies, which were published in the Singapore Medical Journal from 1994 to 1997. They include interesting cases from all the major anatomical regions and organ systems.
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Others
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 (% HbO2) that is less than 90%. The immediate response in acute situations is to rapidly exclude or treat common conditions such as airway obstruction, pneumothorax...
Others
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 reported cases of gynaecomastia as a presenting feature in thyrotoxicosis, and herein we describe an additional case.
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Others
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 pathologically by enlarged lymph nodal sinuses containing large histiocytes with intact phagocytosed lymphocytes (emperipolesis). They dubbed the entity “sinus histiocytosis with massive lymphadenopathy” (SHML or...
Others
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 foreign, together with autonomous activity which is perceived as independent of voluntary control, as if the hand is driven by an external agent.
This article is...
Others
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 clinical application of transcatheter balloon dilation of PVS in 1982, the latter has become the treatment of choice for children with PVS who have significant...
Others
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 course of radiotherapy, following which he was examined three monthly and was found to be free of disease in the nasopharynx and the neck.
This article...
Others
A Case Report of Atasoy Antenna Procedure
The hook nail deformity is a relatively common problem after fingertip amputations. It is usually ignored but can be quite disabling.
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Others
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 these include the transcervical approach, partial sternotomy, median sternotomy and a combination of the transsternal and transcervical approaches.
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Others
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 have rarely been described.
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Others
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 features received little attention until 1936 when Heerfordt’s syndrome of uveitis, salivary gland enlargement and cranial nerve palsies was recognised as a sign of sarcoidosis.
This...
Original Article
Bone Mineral Density—Correlation between Quantitative Ultrasound Characteristics and Dual Energy X-ray Absorptiometry
Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various methods for measuring bone mineral density (BMD). Dual-energy X-ray absorptiometry (DXA) has proven so far to be reasonably precise (about 1% to 2%) and accurate...
Original Article
Outpatient Treatment of Middle and Lower Ureteric Stones: Extracorporeal Shock Wave Lithotripsy versus Ureteroscopic Laser Lithotripsy
Significant technological advances have been made in the management of ureteric calculi. The newer semirigid, fibreoptic ureteroscopes can now be passed with minimal trauma and in many cases without dilatation.
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Others
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 ionic shift from acid-base anomalies and tissue trauma. We report a rare and erstwhile unencountered cause of serum hyperkalaemia in our intensive care unit (ICU),...
Others
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 optimum mode of support varies with individual patients, but none can reliably prevent progression of acute lung injury and high frequency ventilation (HFV) has been...
Others
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 and pathological observations in patients with advanced disease. Today, more than a century later, advanced imaging techniques and biochemical tests have allowed us to identify...
Others
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 fungus, Claviceps purpurea, which elaborates the ergot alkaloids.
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Others
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. The first documentation of familial systemic disease was by Orabona and Albano who reported its occurrence in two sisters some five years later.
This article is...
Others
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 community to consume fish without it being de-boned.
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Others
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.
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Others
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 over by a wagon resulting in bilateral suprapubic dislocation of his testes.
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Others
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 UK. Peak fertility and childbearing years correspond to the first half of this period.
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Others
Trilateral Retinoblastoma—A Case Report
Retinoblastoma is the third most common tumour in childhood. It is inherited genetically.
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Others
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.
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Others
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 angiokeratoma circumscriptum.
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Review Article
A Review of the Role of Magnetic Resonance Imaging in the Evaluation of Shoulder Impingement Syndrome and Rotator Cuff Tendon Tears
In the evaluation of chronic shoulder pain and dysfunction clinically suspected to be due to shoulder impingement syndrome and rotator cuff tendon tears, magnetic resonance imaging (MRI) has virtually replaced double contrast shoulder arthrography. MRI has the advantage of demonstrating the shoulder joint in multiple anatomical planes with excellent...
Original Article
Haematuria in the Diagnosis of Urinary Calculi
Patients with renal or ureteric colic are commonly seen at our Emergency Department. We routinely check their urine for haematuria using the Combur 9 test (Boehringer Mannheim, Germany) alone without doing urine microscopy unless the patient shows pyuria on the Combur 9 test.
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Original Article
Portable Chest Radiography: Comparison of High-resolution Digital Displays with Laser Printed Digital Film
In most institutions, about 10% to 25% of imaging examinations are recorded digitally (e.g. digital subtraction angiography, computed tomography, magnetic resonance imaging and ultrasound). Conventional-projection radiographic studies are still displayed in an analog fashion (on film).
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Original Article
Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome
Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with the advent of modern non-invasive imaging techniques, percutaneous techniques performed under imaging guidance have, over the recent years, become increasingly acceptable as a suitable alternative...
Original Article
Contrast-Enhanced Magnetic Resonance Imaging of the Internal Auditory Canals and Posterior Fossa
Contrast-enhanced magnetic resonance imaging (MRI) is now the gold-standard examination for the exclusion of acoustic schwannomas or other posterior fossa tumours. We retrospectively reviewed 314 cases done over a period of 2 years and 9 months, correlating presenting symptoms with scan findings.
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Others
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 the upper gastrointestinal tract (GIT) are well known and well described.
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Others
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 and lower back. There was no antecedent trauma.
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Review Article
Imaging of Thoracic Manifestations of Scleroderma
Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys, and heart. The American College of Rheumatology has proposed that for the purpose of clinical trials and surveys, the diagnosis is made if the patient...
Review Article
Overview of Imaging in Rheumatologic Diseases
Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations and advances in technology in imaging and interventional radiology today enable more precise and earlier detection, assessment and treatment.
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Others
Osteoid Osteoma after a Stress Fracture of the Tibia: A Case Report
A 24-year-old man complained of left leg pain following 3 months of infantry training 6 years ago. There was no previous complaint of pain over his left leg and there was no trauma.
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Others
Reconstruction of a Supinated Hypoplastic Thumb with Combined Huber Transfer and Derotation Osteotomy: A Case Report
A 6-year-old Chinese girl presented with a deformity of the left thumb since birth. Her father has a similar deformity.
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Others
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 and result in tachycardia-related cardiomyopathy. Early strategies to manage this problem such as pharmacological therapy to either block the atrioventricular node or suppress the ectopic...
Others
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.
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Others
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 220th case.
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Others
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 occlusion of a cerebral artery.
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Others
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 infection with this organism was reported by King in 1959.
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Others
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 presence of a malignancy.
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Others
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 linear deposits of IgA along the dermoepidermal junction. It usually occurs acutely in pre-school children and has been described in association with a variety of...
Others
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 or opportunistic mycobacteria.
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Original Article
Focused Abdominal Sonography for Trauma (FAST)
The multiply injured patient presents a challenge to even the most experienced surgeon. These patients often present in shock and require a rapid diagnostic work-up to determine the presence of ongoing haemorrhage.
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Original Article
Is Staging of Benign Prostatic Hyperplasia (BPH) Feasible?
Staging of disease is important. It serves as a guide for further management and also for comparing the results of treatment. Traditionally this has been used for malignant disease.
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Others
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 the primary correction of these deformities. Ross reported that approximately 25% of patients developed maxillary hypoplasia that was refractory to orthodontic management alone.
This article is...
Others
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 the immature erupting teeth is loosely structured, providing minimal resistance to extrusive forces. Falls against hard objects, including those incurred during sports activities, are one...
Others
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 investigations have proven its clinicopathologic diversity.
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Others
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 shown that a clinical entity known as “epidermal nevus syndrome”, formerly used as an alternative term to SS, does not exist.
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Others
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 way craniofacial surgery is planned and its valuable contributions and limitations have been studied.
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Others
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 the first report of disseminated P. marneffei infection in a HIV-infected individual from Bangkok in 1989, the incidence has increased markedly, almost exclusively in patients...
Others
Extraarticular Villonodular Synovitis of the Tendoachilles: A Case Report
Pigmented villonodular synovitis is a progressive synovial lesion of uncertain aetiology associated with synovial-lined tissues of the joints, tendon sheaths and bursae. The incidence was 1.8 patients per million population.
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Others
Embolisation of a Leaking Pseudoaneurysm of the Main Artery Supplying a Replanted Arm: A Case Report
Pseudoaneurysms are conventionally treated by surgery. In recent years, non-surgical methods are being considered, including embolisation with wires, coils or gelfoam and anticoagulation.
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Others
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 receptor activity than the older tricyclic antidepressants. However, like tricyclic antidepressants and other groups of antidepressants such as the monoamine oxidase inhibitors (MAOIs) and the...
Others
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 limb muscles. It usually develops secondary to brainstem or cerebellar disease (symptomatic palatal myoclonus) interrupting the central tegmental tract or dentato-olivary fibres.
This article is available...
Others
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.
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Others
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 severe tenderness in the lumbar region, limited straight leg raising but no neurological deficit.
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Others
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 Ayurvedic medicine practitioners, tout the ability to heal many diseases using treatments which are unconventional and of questionable scientific basis.
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Others
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 morbidity and mortality attributable to malaria in recent years follows the loss, in the early 1970s, of the impetus and impact of the initial WHO...
Others
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 histological typing of skin tumours, it is an eccrine carcinoma that may arise de nova or develop in eccrine poroma, its benign counterpart, as an...
Others
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 release approach and posterior instrumentation. Preoperative assessment revealed good effort tolerance.
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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 is from the deep penetrators from the middle cerebral and anterior cerebral arteries.
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Original Article
Magnetic Resonance Imaging of Brain Metastases: Magnetisation Transfer or Triple Dose Gadolinium?
Accurate detection of brain metastases is an important part of tumour staging. Magnetic resonance (MR) imaging is well accepted as a sensitive tool in the detection of brain metastases.
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Original Article
The Outcome of Trial Off Catheter after Acute Retention of Urine
Acute retention of urine (ARU) is the commonest urological condition requiring emergency admission to hospital and is usually managed by urethral catheterisation. Previously, patients with long-standing bothersome symptoms and who present with first episode of ARU were offered transurethral resection of prostate (TURP).
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Original Article
Renal Cell Carcinoma in Patients with Chronic Renal Failure
Dunnil and associates first described the association of renal cell carcinoma (RCC) with acquired cystic kidney disease (ACKD) and end stage renal disease. The incidence of ACKD in dialysis patients ranges from 10% to 90% depending on the duration of dialysis.
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Original Article
Inferior Vena Cava Thrombectomy for Renal Cell Carcinoma with Thrombus
A characteristic feature of renal cell carcinoma is the development of tumour thrombus extending into the inferior vena cava (IVC). This takes place in 4% to 10% of cases.
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Original Article
Radiological Placement of 211 Central Venous Catheters: Outcome and Complications
Long-term central venous access is an important part of modern medical practice, especially in the haematology and oncology units. Central venous (CV) catheters are used for the administration of anti-neoplastic agents, immunosuppressive drugs, antibiotics, blood components, hyperalimentation, for frequent blood sampling, and for acute and temporary haemodialysis prior to...
Others
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 mercury vapour, though rare, are well documented in the literature.
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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 some such findings in these children1 Mild to moderate hypoxaemia is also well described in children with chronic liver disease.
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Others
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™) was first attempted on the dorso-lateral aspect of the right wrist at the base of the anatomical snuffbox.
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Others
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 in the late stages of renal tuberculosis and results in greater loss of renal function than direct involvement by tuberculosis alone.
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Others
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.
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Original Article
Current Indications for Open Stone Surgery in Singapore
The treatment of urinary calculi has changed tremendously since the introduction of extra corporeal shockwave lithotripsy (ESWL), percutaneous nephrostolithotomy (PCNL), and ureteroscopy over the past decade in our hospital. Patients previously requiring open surgical procedure are now treated successfully with these new therapeutic modalities.
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Original Article
Role of Ultrasonography in Screening for Urological Malignancies in Patients Presenting With Painless Haematuria
Haematuria of any degree should never be ignored and, in adults, it should be regarded as a symptom of urological malignancy until proven otherwise. Mariani et al, in their evaluation of 1000 consecutive patients, revealed life-threatening lesions in 9.1% of cases.
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Commentary
Tissue Microangiography Using a Simplified Barium Sulphate Cadaver Injection Technique
The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections, combined with injections to outline the blood supply.
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Original Article
Nitric Oxide Synthase-Its Distribution and Alteration in the Intramural Ganglia of the Urinary Bladder in Normal and Urethra-obstructed Guinea Pigs
Nitric oxide (NO) has been recognised as a nonadrenergic noncholinergic (NANC) inhibitory neurotransmitter at various sites in the nervous system. Its function as a NANC inhibitory transmitter has been documented in muscular and sphincter relaxation in the cardiovascular, digestive and urogenital system.
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Original Article
Radionuclide Studies of Articular Cartilage in the Early Diagnosis of Arthritis in the Rabbit
Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis of osteoarthritis.
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Others
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 years. It has been noted as an incidental finding in autopsy, echocardiography and angiography, but can present with symptoms of cough, dyspnoea, hoarseness of voice...
Others
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 present.
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Others
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, whereas those of lower airway obstruction are worse in expiration.
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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 renal physician for pruritic rashes over the scalp and chest. The rashes were first noted about 3 months ago.
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Others
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 minutes of strenuous exercise, usually after the exercise has ceased.
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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 functional endoscopic sinus surgery for mild obstructive sleep apnoea and chronic sinusitis respectively. He weighed 109 kg, all his four upper incisors were missing and...
Others
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 from neuroepithelial cells, possibly derived from the peripheral intercostal nerves. They could also arise from the neural crest cells, which have migrated alongside the peripheral...
Others
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.
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Others
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 an episode of upper respiratory tract infection (URTI). He had hearing loss with tinnitus in the right ear, nasal obstruction with greenish nasal discharge and...
Original Article
Transurethral Alprostadil for the Treatment of Erectile Dysfunction: Results of a Multicentre Trial
As the population is growing older and the society getting more affluent, people are aiming for a better quality of life. This has resulted in greater awareness of erectile dysfunction (ED), thus increasing the number of patients approaching the doctor for consultation.
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Original Article
Evaluation of Technetium-99m Ciprofloxacin (Infecton) in the Imaging of Infection
Over the past 10 years we have used various radiopharmaceuticals (RPCs) for imaging of inflammation and infection. These include gallium-67 citrate and the technetium-99m labelled nanocolloids, immunoglobulin (IgG), antigranulocyte antibodies (AGAB) and HMPAO-labelled leukocytes.
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Laparoscopic Telesurgery Between the United States and Singapore
Telemedicine is the use of telecommunication technologies to provide medical information and healthcare services. Early applications include medical use of the telephone and facsimile.
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Others
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, especially in the lower third, may result in fractures of the mandible.
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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 patients.
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Others
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 urticaria is often obscure and not easily treatable.
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Others
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 roentgenogram. He had experienced progressive dyspnoea on exertion associated with cough productive of whitish sputum for 6 months preceding this evaluation in April 1998.
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Others
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 varying proportions.
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Others
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 G<sub>M2</sub> gangliosides, particularly in the neuronal cells. The infantile form, similar to Tay Sach’s disease, may present in the first year of life with an...
Others
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 the commonest of these disorders, and a leading cause of heart block in newborns.
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The Genetics of Primary Vesico-Ureteric Reflux
Vesico-ureteric reflux (VUR, OMIM #193000), the name given to reflux of urine from the bladder into the ureter and towards the kidney, is believed to be due to a developmental abnormality of the ureteric bud during embryogenesis. Ureteral reflux has been known for centuries; in the 15th century Leonardo...
Commentary
Transurethral Surgery and the Adductor Spasm
Bladder tumours frequently arise from the posterolateral wall of the bladder1 over the course of the obturator nerve. It is during transurethral resection of these tumours that direct electrical stimulation of the obturator nerve occurs.
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Others
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.
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Others
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, India.
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Others
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 for 6 weeks, purple discolouration of the toes for 3 months and arthritis of the left knee for 3 months.
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Others
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 separate entities but clinical overlap occurs.
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Others
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) and the sleep hypopnoea syndrome are well-known and well-described breathing disorders during sleep.
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Original Article
Six-Year Follow-Up of Untreated T1 Carcinoma of Prostate
It is well known that T1 carcinoma of the prostate has varying biologic behaviour. Attempts to identify those at higher risk of progression have led to the subclassification into T1a (focal, low grade) and T1b (diffuse, high grade).
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Original Article
Cystoscopic Diagnosis of Bladder Cancer by Intravesical Instillation of 5-Aminolevulinic Acid Induced Porphyrin Fluorescence—The Singapore Experience
Bladder cancer is the sixth most frequent malignant disease in the world. Superficial stages of the tumour are found in 75% to 85% of cases upon first diagnosis.
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Others
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 ugly. Body dysmorphic disorder appeared in DSM-III in 1987.
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Others
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 anticancer activity has been demonstrated.
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Others
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 disease (COPD). Despite smoking cessation for 5 years, and pharmacological treatment with oral theophylline, inhaled ipratropium bromide and ventolin, his dyspnoea had progressed to the...
Others
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. asteroides, N. brasiliensis and N. caviae are responsible for nearly all nocardial infections in man.
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Others
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 the heart.
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Others
A Case Report of Total Finger Joint Replacement Arthroplasty After Traumatic Amputation
A 41-year-old Chinese man had his dominant thumb, index and middle fingers caught by a wood-cutting machine while at work. He sustained a near-amputation of his middle finger through the proximal interphalangeal joint (PIPJ), with an intra-articular comminuted fracture of the head of the proximal phalanx (Fig. 1a) and...
Others
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 haemagglutination (IHA) test and various antigen detection tests. Gram stain shows a bipolar “safety-pin” pattern or small gram-negative rods.
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Others
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, papules, nodules and occasionally bullae (termed bullous amyloidosis in the literature), predominantly distributed over the periorbital and intertriginous areas. In contrast, lichen amyloidosus is solely...
Others
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 in females.
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Others
Diagnosis of Pacemaker Lead Infection Using Transoesophageal Echocardiography: A Case Report
The expanding indications for permanent cardiac pacing mandate an awareness of the potential complications associated with device implantation. After failure of pacing and sensing, infection is the most frequent pacemaker-related complication, with reported rates of between 1% to 7% in older studies1 and <1% in more recent series.
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Others
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.
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Others
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 and arms of 3 years’ duration. He had noted sun-aggravation and had ceased working for 3 months.
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Others
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 Singapore. This situation may change.
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Others
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. He has travelled several times in the past few years to caves in Kuala Lumpur for worship.
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Others
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 pouch and are characteristically lined by a single layer of ciliated cuboidal or columnar epithelium with goblet cells. However, foci of squamous epithelium in Rathke’s...
Others
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. His past medical history included asthma, chronic anal fissure and haemorrhoids, cervical spondylosis and mild hypercholesterolaemia.
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Others
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 have subsequently been identified in the thyroid, parathyroid, salivary and adrenal glands.
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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 a large redundant skin envelope and the breast volume may be reduced or distorted compared with the normal side.
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Others
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 found in less than 1%. The majorities are papillary and mixed papillary-follicular carcinomas, with follicular and squamous cell carcinomas occurring far less frequently.
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Others
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.
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Original Article
Digital Hand-held Sonography Utilised for the Focused Assessment with Sonography for Trauma: A Pilot Study
On a global basis, the use of ultrasonography to assist clinicians in obtaining timely diagnoses in abdominal trauma is not particularly new. The first reported case of sonography to evaluate patients with splenic haematomas was in 1971, and by 1976, series of up to 70 victims of blunt trauma...
Original Article
Acute Renal Colic: Value of Unenhanced Spiral Computed Tomography Compared with Intravenous Urography
The typical ureteric calculus presents with an acute onset of flank pain which may radiate to the groin. Intravenous urography (IVU) has classically been the gold standard for the diagnosis of urinary calculi.
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Original Article
Holmium Laser Lithotripsy in the Management of Ureteric Calculi
The introduction of extracorporeal shockwave lithotripsy (ESWL) in the 1980s revolutionised treatment of renal and ureteric calculi. Progress in the field of extracorporeal lithotripsy was paralleled by the introduction of smaller caliber ureteroscopes and various intracorporeal lithotripters.
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Others
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 radiation therapy for the treatment of HCC.
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Others
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 more compact and less trabeculated than the right ventricle.
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Others
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 region. They are commonly found in the soft tissues of the neck, back and extremities.
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Original Article
The Singapore General Hospital Early Clinical Experience with the 7.5F Flexible Ureterorenoscope
Intravenous regional anaesthesia (IVRA) has a reported success rate of between 94% and 98% for upper limb surgery. Limitations to its use include the quality of intraoperative anaesthesia, tourniquet pain and lack of adequate postoperative analgesia.
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Original Article
Spectrum of Prostate Cancer in the Singapore General Hospital (1980 to 1985)
Prostate cancer is the most prevalent cancer among men in the United States. In Singapore, it is the sixth most common incidence of cancer among males and the age-adjusted rates have risen from 8.2 to 9.6 per 100,000 per year between 1987 and 1992.
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Others
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 or with symptoms caused by excess of counterregulatory hormones like catecholamines, such as palpitations, sweating and tremulousness. It is most commonly seen in patients with...
Others
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 syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...
Others
Clinical Reasoning Learning Sessions
Many medical schools worldwide have made the shift toward problem-based learning (PBL) medical education. Some of them employ these new techniques in only part of their teaching, and usually in the pre-clinical phases, to make basic sciences easier and more attractive.
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Others
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 pseudomyxoma peritonei.
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Others
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.
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Others
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, being the putative testicular determining factor (TDF) governs testicular gonadogenesis. Yet, there are distinct situations where sexual differentiation proceeds along a female phenotype despite the...
Others
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 benign course in the majority of patients. In a 1981 study, the incidence of radiologically detectable bone disease was found in 24% of patients but...
Others
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 12% and about 0.7% are reported to have central nervous system infection e.g. epidural abscess or meningitis.
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Others
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 episode of gross haematuria and 2 months of back pain. Investigations showed evidence of disseminated intravascular coagulation (DIVC) and compression fracture of T10 vertebra.
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Others
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, the most important and life threatening complication being acute renal failure. Early implementation of preventive measures can have a drastic impact on reducing the associated...
Others
Galeazzi-Equivalent Fracture in Children Associated with Tendon Entrapment—Report of Two Cases
A 12-year-old boy fell whilst running. On examination, there was swelling and deformity of the wrist and there was local tenderness of the distal third of the radius and the distal end of the distal ulna. Movement of all the fingers and thumb were limited by pain.
This article is...
Others
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 1977.
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Others
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 short arm of chromosome 20.
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Others
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 local literature. Earlier local reports have alluded to the fact that sarcoidosis may be more common amongst Indian females and that more cases may be...
Others
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 male which, to our knowledge, is the first reported case out of Southeast Asia.
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Others
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 unusual cause of intestinal obstruction occurs in 4% of all cases of acute intestinal obstruction.
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Original Article
A Twelve-year Review of Radical Cystectomies in Singapore General Hospital
Bladder carcinoma is the tenth most common cancer affecting men in Singapore. It is more common in men with an age-standardised incidence rate of 6.9 per 100,000 per year for men and 1.7 per 100,000 per year for women in Singapore.
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Others
Magnetic Resonance Arthrography of the Labral-Ligamentous Complex of the Shoulder: An Update
Shoulder instability is a frequently encountered clinical problem in young active people following injury, particularly in athletes. The labral-ligamentous complex is increasingly recognised as being an important structural component that contributes to shoulder instability.
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Original Article
Limited Magnetic Resonance Imaging (MRI) and the Occult Hip Fracture
Worldwide, in the past decade, the application of magnetic resonance imaging (MRI) has increased tremendously in the management of musculoskeletal trauma. Not least is its application as a valuable diagnostic tool in occult hip fracture evaluation.
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Others
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 laryngospasm on extubation of a Benjamin jet tube resulting in pulmonary haemorrhage.
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Others
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 an important adage not to be forgotten.
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Others
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 epidural gone astray, and the lowest reported volume of local anaesthetic used was 3.5 mL.
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Original Article
Percutaneous Nephrolithotomy in the Management of Complex Upper Urinary Tract Calculi: The Singapore General Hospital Experience
Open surgical removal had been the standard treatment for urolithiasis till the early 1980s when introduction of percutaneous techniques and extracorporeal shock wave lithotripsy (ESWL) revolutionised stone management.
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Others
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 more frequently in women than men.
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Others
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 report the course of pregnancy in a patient with such a condition.
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Others
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 VIII and prevent the successful arrest of bleeding episodes when administered to these haemophiliacs.
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Others
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.
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Others
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 conditions and conventional rigid gas-permeable (RGP) corneal contact lenses though useful in less severe disease, are poorly tolerated by those with progressively worsening keratoconus and...
Others
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 to 3 months) after starting allopurinol.
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Others
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.
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Others
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 of rejection, infection, immunosuppression and declining donor pools.
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Original Article
The Role of BTA stat in Clinical Practice
Cystoscopy, supplemented by urine cytology, remains the gold standard in detecting primary and recurrent bladder cancer. Urine cytology, although highly specific, detects only 29% to 45% of bladder tumours and is subject to considerable inter- and intra-observer differences.
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Original Article
Technetium-99m Methoxyisobutylisonitrile Imaging in the Follow-up of Differentiated Thyroid Carcinoma
Differentiated thyroid carcinoma (DTC) is not an uncommon tumour in Thailand.1 A high percentage of 10-year survival results in long-term follow-up. I-131 total-body scan (I-131 TBS) is commonly used for monitoring the disease after surgery and radioiodine ablation in most centres.
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Original Article
Penile Colour Duplex Ultrasonography as a Screening Tool for Venogenic Erectile Dysfunction
Penile colour flow Doppler imaging (PCDI) is a non-invasive, accurate and cost-effective technique. It has better patient acceptance as compared to cavernosometry and cavernosography, and it does not involve any ionising radiation.
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Others
A Case Report of Neurologically Unstable Fracture of the Lumbosacral Spine in a Patient with Ankylosing Spondylitis
Ankylosing spondylitis is associated with progressive ossification of the spinal ligaments and ankylosing of the facet joints leading to a totally stiff spine. It is often associated with osteoporosis due to chronic inflammation and disuse.
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Others
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.
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Others
Embolisation of a Renal Artery Pseudoaneurysm in a Patient with Renal Malrotation and Chronic Aortic Dissection
A 40-year-old Chinese male presented with severe right loin pain. He had a history of chronic abdominal aortic dissection of unknown aetiology. He was not hypertensive and there was no evidence of ankylosing spondylitis, Ehlers-Danlos syndrome or any connective tissue disorder.
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Original Article
Single Centre Review of Radiologically-guided Percutaneous Nephrostomies: A Report of 273 Procedures
Percutaneous nephrostomy (PCN) is a well-established technique in the armamentarium of an interventional radiologist when dealing with urinary obstruction. It provides temporary relief in obstructive uropathy and stabilises the patients for subsequent definitive treatment.
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Original Article
To Establish the Normal Bone Mineral Density Reference Database for the Singapore Male
Bone mineral densitometry was developed as a means to quantify the bone mineral content of the skeleton accurately and has been used in the diagnosis of osteopenia and osteoporosis. Dual-energy X-ray absorptiometry (DXA) of the axial skeleton is one such technique2 which is based on a subtraction method.
This article...
Original Article
Percutaneous Vertebroplasty in the Management of Osteoporotic Vertebral Compression Fractures: Initial Experience
With the general increase in life expectancy in the local population, the incidence of osteoporosis is anticipated to rise as well. Even with screening modalities such as bone mineral densitometry and preventive treatment such as hormone replacement therapy, many patients are asymptomatic and are diagnosed with osteoporosis only after...
Original Article
Differentiation of Malignant Vertebral Collapse from Osteoporotic and Other Benign Causes Using Magnetic Resonance Imaging
An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult to differentiate between benign and malignant causes for the vertebral collapse.
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Others
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%.
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Others
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 of their size.
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Others
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 control the haemodynamic fluctuations during phaeochromocytoma resection.
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Letter to the Editor
Letter to the Editor
We would like to draw the attention of your readers to the comments made in the editorial of the recent Imaging issue of your journal.
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Others
Imaging-guided Bone Biopsy
Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety of modalities, such as fluoroscopy1 and computed tomography (CT), and less commonly, ultrasonography (US) and magnetic resonance (MR) imaging.
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Others
Carcinoma of the Cervix: Role of MR Imaging
In females with cancer, cervical carcinoma is second to breast cancer in both incidence and mortality worldwide. About 465,000 new cases are diagnosed each year in both developing and industrialised nations, with a higher incidence in women of low socioeconomic status.
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Others
Intracerebral Schwannoma—A Rare Cause of Epilepsy
Schwannomas are extra-axial neoplasms derived from the nerve sheath of peripheral or cranial nerves. They represent approximately 8% of all intracranial tumours, arising predominantly from the vestibular nerve.
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Others
Radiographic Features of a Case of Severe Acute Respiratory Syndrome with Fatal Outcome
Severe acute respiratory syndrome (SARS) is an atypical pneumonia that was first reported in early 2003. Reports of outbreaks of cases rapidly appeared in Hong Kong, Vietnam, China and Singapore.
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Others
Clinical Applications of MR Cholangiopancreatography
Magnetic resonance cholangiopancreatography (MRCP) has attracted a lot of interest from clinicians because it is a non-invasive method of obtaining a cholangiographic image without the morbidity that is associated with endoscopic retrograde cholangiopancreatography (ERCP).
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Others
Imaging of Paediatric Mediastinal Masses
A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for thoracic masses in children.
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Review Article
Clinical Positron Emission Tomography Imaging—Current Applications
Like other radionuclide techniques, positron emission tomography (PET) is based on the tracer principle – a small amount of labelled ligand is used to trace the metabolic pathway of an important chemical in the cell. PET complements anatomic imaging by its ability to map function or metabolism.
This article is...
Review Article
MR Imaging and MR Spectroscopy of Adenocarcinoma of the Prostate
Prostate cancer is usually suspected due to an abnormal digital rectal examination, elevated serum prostate specific antigen (PSA) level or both. The diagnosis of prostate cancer depends on histopathologic examination of tissue obtained from systematic sextant core needle biopsy under transrectal ultrasound guidance.
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Review Article
Imaging of Congenital Middle Ear Deafness
When a child or young adult with morphologically normal external ears and no previous history of ear discharge or trauma presents with conductive hearing deficit, a congenital middle ear anomaly should be sought. Although fenestral otosclerosis is a differential diagnosis, the early onset of symptoms and a lack of...
Review Article
MR Imaging of the Fetal Brain and Spine: A Maturing Technology
The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.
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Review Article
Imaging of Acquired Immunodeficiency Syndrome (AIDS)
The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of death worldwide. There are now 60 million deaths recorded from the infection worldwide by the United Nations AIDS (UNAIDS) organisation, most of them in sub-Saharan...
Review Article
The Singapore National Breast Screening Programme: Principles and Implementation
In January 2002, the first population-based national mammographic breast screening programme in Asia, the Singapore National Breast Screening Programme (BreastScreen Singapore), was launched. The programme aims to achieve international standards of breast screening practice and breast cancer detection, as well as to reduce or stabilise the mortality from breast...
Original Article
Brachiocephalic-Superior Vena Cava Metallic Stenting in Malignant Superior Vena Cava Obstruction
A large majority of superior vena cava (SVC) syndrome is caused by malignancy (74% to 95%). This can either be due to direct SVC invasion or secondary to extrinsic compression.
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Original Article
Pilot Study Using Technetium-99m Pertechnetate Sequential Radionuclide-Sialography to Assess Salivary Gland Function in Nasopharyngeal Cancer Patients on Radiation Therapy
Nasopharyngeal carcinoma (NPC) is an epithelial malignancy occurring worldwide with particularly high frequencies in the Far East. The incidence is highest in Hong Kong followed by Singaporean Chinese.
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Original Article
Breath-hold Fast Recovery Fast Spin Echo versus Conventional Non-Breath-hold Fast Spin Echo T2-Weighted MR Imaging of Focal Liver Lesions
T2-weighted magnetic resonance (MR) imaging is an important sequence for characterisation of focal liver lesion. Accurate characterisation of benign lesions, such as haemangioma or cyst, is important to prevent unnecessary procedure or surgery.
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Original Article
Diffusion-weighted MR Imaging in Intracranial Infections
Diffusion-weighted magnetic resonance (MR) imaging (DWMRI) is becoming essential to the assessment of acute cerebral infarction and has also been applied to distinguish cerebral abscess from necrotic intracranial neoplasm. There have also been a few case reports on DWMRI of encephalitis.
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Original Article
Preoperative High Resolution CT and MR Imaging in Cochlear Implantation
Candidates for cochlear implantation undergo a thorough audiological and medical assessment. The audiological assessment is done to ensure that these candidates who have bilateral profound or severe hearing loss have been given adequate hearing amplification, but show no significant benefit.
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Original Article
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of the mammogram remains the basic policy, as was recommended in the Forrest report.
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Original Article
Breast Cancer in Women Under 40 Years: Preoperative Detection by Mammography
The incidence of breast cancer peaks between the ages of 45 and 55 years. Approximately 7% of breast cancers occur below 40 years of age.
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Editorial
The Past Decade of Diagnostic Radiology in Singapore: How Much Progress Have We Really Made?
It has been 10 years since the first ever issue of Annals dedicated to “Radiology” was published in Volume 22 No. 5 September 1993. Keeping in mind the tremendous growth in the development and applications of Imaging for both Diagnosis and Intervention, this second theme issue is long overdue.
This...
Others
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 200 mL of blood after a severe bout of vomiting. She declined a oesophago-gastro-duodenoscopy (OGD) and was clinically diagnosed to have Mallory-Weiss syndrome.
This article is...
Others
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.
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Others
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, attention has been turned towards the use of class III drugs for the management of both atrial and ventricular arrhythmias. While the adverse effects of...
Review Article
Advances in Imaging in Prenatal Diagnosis and Fetal Therapy
Technology in sonography has advanced tremendously in recent years, contributing to improvements in clinical applications for prenatal diagnosis and fetal therapy. These include transvaginal scanning, harmonic imaging, Doppler imaging, 3-dimensional (3D) ultrasonography and magnetic resonance imaging (MRI) ultrafast sequences.
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Review Article
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
Colorectal cancer is the second most common cancer in Singapore, accounting for 15.9% of all cancers registered with the Singapore Cancer Registry in the years between 1993 and 1997. Despite recent advances in surgery, radiotherapy and chemotherapy, more than half of those afflicted will die from their cancer.
This article...
Original Article
Computed Tomographic Appearance of Colorectal Hepatic Metastases
It is important to recognise the computed tomography (CT) appearance of hepatic metastases from colorectal primaries, as resection in a selected group may offer a 20% to 40% rate of five-year survival compared to 5% to 10% with non-surgical management.
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Review Article
Current Status in Imaging of Colorectal Liver Metastases
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the time of clinical presentation, with an additional 30% developing clinical evidence of hepatic disease within 24 months.
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Others
Routine Abdominal and Pelvic Ultrasound Examinations: An Audit Comparing Radiographers and Radiologists
Since its introduction into clinical practice in the early 1970s, ultrasound (US) has become firmly established as an extremely valuable imaging modality and widely used to the extent that abdominal US is the second most commonly performed imaging study (after chest radiography). Our department has also experienced a steady...
Others
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 early and operable breast cancer.1 Most neoadjuvant chemotherapeutic regimes contain an anthracycline and are usually combined with cyclophosphamide, with or without 5-fluorouracil.
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Others
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 2-year mortality is more than 50% despite vasodilators, anticoagulants, systemic corticosteroids and cytotoxic drugs.
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Original Article
Clinical Utility of Selective Intra-arterial Calcium-stimulated Hepatic Venous Sampling in Regionalisation of Insulinomas—The Singapore Experience
Insulinomas are small tumours with dimensions that seldom exceed 2.0 cm in diameter. Preoperative non-invasive localisation using trans-abdominal ultrasound and conventional computed tomography (CT) detect only between 25% and 60% of insulinomas.
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Others
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 of an acute swelling at the floor of the mouth for 2 days. The patient was seen the day before in an outpatient clinic and...
Others
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 the ectoderm surrounding the peripheral of the tongue, forming the lingual sulcus separating the tongue and the floor of the mouth. The anterior boundary is...
Others
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 multiple dental caries, phenytoin-induced gingival hyperplasia and severely worn-down and eroded dentition. He is under regular follow-up by the Paediatrics Department of the National University...
Others
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 institute treatment as soon as possible, as they can lead to serious involvement in other mucosal and cutaneous sites and even death.
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Others
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 tumour occurs mostly in the mandible and grows slowly with variable clinical and histological characteristics, but it is histologically benign.
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Others
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 connective tissues, vessels and with an eosinophilic inflammatory component.
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Others
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 this condition.
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Others
Characteristics of Six Newborn Infants with Postnatal Findings of Severe Intracranial Haemorrhage
A postnatal finding of intracranial haemorrhage carries potential medico-legal implications for the obstetrician. However, one cannot exclusively attribute this to birth trauma.
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Original Article
Transurethral Resection of Prostate (TURP) Through The Decades – A Comparison of Results Over the Last Thirty Years in a Single Institution in Asia
Over the last 70 years, transurethral resection of prostate (TURP) has been used in the surgical treatment of benign prostatic hyperplasia (BPH) and is still considered the gold standard. With improvements in operative techniques, video endoscopy, anaesthetic care and intraoperative monitoring of fluid and electrolytes, rates of intraoperative and...
Original Article
Morbidity and Significant Bacteriuria after Urodynamic Studies
Urodynamics or pressure flow studies (PFS) are defined as a functional assessment of the lower urinary tract (LUT) to provide a pathophysiological basis for urinary symptoms and signs. Advocates of PFS deem it a necessary investigation if continence surgery is contemplated, stating that the “bladder is an unreliable witness”...
Others
Reflections of a Septuagenarian – Radiology: Past, Present and Future
Before I commence, I would like to thank the Singapore Radiological Society and the Chapter of Radiologists of the Academy of Medicine for inviting me to speak today on the occasion of the inauguration of the FY Khoo Lectureship. I was initially hesitant.
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Others
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 is seen in fewer than 3% of all cases of sinusitis.
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Others
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 1.0 per million population. However, the incidence of CJD in the Singaporean population is not known. With a population of 4 million, an estimated 2...
Others
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% of thoracoabdominal trauma patients. The diagnosis is often difficult and delay in diagnosis is implicated in increased morbidity and mortality.
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Others
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 common cause of CNV is age-related macular degeneration but it may also occur secondary to a variety of other aetiologies such as pathological myopia, ocular...
Others
Imaging Findings in Acute Neck Infection due to Pyriform Sinus Fistula
Pyriform sinus fistula is a developmental abnormality of the 3rd or 4th branchial pouch. It usually presents in childhood as acute inflammatory swelling of the neck and frequently involves the thyroid gland.
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Original Article
Audit of Diagnostic and Interventional Craniocervical Catheter Angiographic Procedures at the Singapore General Hospital
Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast and spatial resolution, as well its high selectivity and ability to show the full extent of vascular disease, presence of contralateral disease, patterns of collateral...
Original Article
Breast Ultrasound in Women With Familial Risk of Breast Cancer
Mammography is the modality of choice to screen for breast cancer in asymptomatic women. However, it is known that about 10% to 12% of breast cancers are mammographically occult.
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Others
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 a mitotic arrestant, appropriate hypotonic treatment and adequate fixation with modified Carnoy’s fixative.
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Others
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 lymphadenitis in children. To date, less than 100 patients with this infection have been reported worldwide.
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Others
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 of the peritoneal cavity is not advised.
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Others
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 histologically, and was originally termed “scleromyxoedema-like illness of haemodialysis”.
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Others
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, Falk et al described and characterised the tumoural component.
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Others
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 the term “pulmonary eosinophilia” for disorders characterised by chest radiographic infiltrates and peripheral eosinophilia.
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Review Article
Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging
Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there has been a dramatic increase in the survival rate of patients.
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Others
A Case of Right Loin Pain: Septic Ovarian Vein Thrombosis Due to Campylobacter fetus Bacteraemia
Septic ovarian venous thrombosis is an uncommon entity. Classically, it occurs as a postpartum complication with reported frequency of 1 in 600 to 2000 deliveries.
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Others
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 left breast with immediate reconstruction using ipsilateral deep inferior epigastric perforator (DIEP) flap was performed.
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Others
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 Singapore. We present 2 cases which illustrate an unusual outcome of an otherwise usual occurrence.
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Others
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 (Beacons Chemicals Pte Ltd, Singapore), a fairly effective chemoprophylactic agent in the management of malaria.
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Others
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.
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Others
Supernumerary Testicle in a Case of Polyorchidism
The presence of more than 2 testicles is called polyorchidism. It is a rare anomaly.
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Others
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 rapidly and re-invade the host.
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Others
Plantar Dislocation of Lateral Tarsometatarsal Joint: A Case of Subtle Lisfranc Injury
Lisfranc fracture dislocations are uncommon injuries and the diagnosis may be easily missed. There are several variations and we present one such variant.
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Others
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 porphyria.
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Others
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 2 months. Clinically, she had left cervical lymphadenopathy measuring 3 cm.
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Others
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 renal capsule and bilateral tumours are very rare.
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Others
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 15 days before he was admitted.
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Others
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 attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...
Others
Profunda Femoris Artery Pseudoaneurysm Presenting with Triad of Thigh Swelling, Bleeding and Anaemia
Pseudoaneurysms of the profunda femoris artery have been reported following blunt and penetrating trauma to the thigh, and orthopaedic procedures of the proximal femur. These pseudoaneurysms can present in various forms, such as a painful pulsatile mass, or even thigh compartment syndrome.
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Others
Clinical Indications for Positron Emission Tomography (PET) Scanning
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their patients. PET imaging is a rapidly evolving field, with ongoing developments in imaging technology, radiochemistry, isotope production, animal research and clinical applications.
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Original Article
Semi-Quantitative Measurements of Normal Organs With Variable Metabolic Activity on FDG PET Imaging
Positron emission tomography (PET) has a proven clinical role in oncology, cardiology and neurology that primarily uses 2-deoxy-2--fluoro-deoxyglucose (FDG). FDG is an analogue of glucose that mimics the cellular uptake and initial metabolism of glucose, which enables cells utilising excess glucose to be visualised. Increased glucose metabolism is commonly...
Review Article
Clinical Applications of Positron Emission Tomography in Cardiology: A Review
Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a poor prognosis when treated medically.
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Review Article
The Role of FDG-PET in the Management of Non-small Cell Lung Carcinoma
Carcinoma of the lung is the leading cause of cancer death in both men and women and is the second most common malignancy in both men and women. In 2003, it is estimated that there will be 171,900 new cases of lung carcinoma diagnosed in the United States and...
Review Article
Clinical PET Imaging – An Asian Perspective
Positron emission tomography (PET) is distinct from other imaging modalities in its ability to probe the physiology and biochemistry of normal and abnormal tissues. It is based on the same principle of tracer kinetics used in conventional nuclear medicine.
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Review Article
PET Tracers and Radiochemistry
Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in large part, to advances in instrumentation and synthetic chemistry.
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Review Article
Physical Principles and Technology of Clinical PET Imaging
The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The emergence of PET as the functional imaging modality of choice for diagnosis, staging, therapy monitoring and assessment of recurrence in cancer has led to an...
Editorial
Positron Emission Tomography – A Vital Component of Molecular Imaging
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of such modalities as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS) and positron emission tomography (PET). As far back as 1951, positron-emitting radiotracers have...
Others
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 cases.
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Others
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 tissue as a result of an underlying defect in calcium and/or phosphate metabolism.
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Others
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 repeat expansions and 16 types of SCAs have been described.
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Others
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 thyroid malignancy. The overall incidence, not surprisingly, varies from 1.25% in unselected patient autopsy series to 24% in autopsy of patients with widespread malignant neoplasms.
This...
Others
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 per 100,000 in the year 2001.
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Original Article
Extracorporeal Shockwave Lithotripsy and Intracorporeal Lithotripsy for Proximal Ureteric Calculi – A Comparative Assessment of Efficacy and Safety
The introduction of extracorporeal shockwave lithotripsy (ESWL) by Chaussy and his co-workers in 1980 revolutionised the management of urinary calculi. Since then, ESWL has become the modality of choice of many urologists for proximal ureteric calculi.
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Others
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.
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Others
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 described in 1961 and the phenotype was subsequently expanded in 1972.
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Others
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 setting, such as nebulisers, water baths, dialysis machines and intravenous fluids.
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Others
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 no prior trauma or back injury. A lumbar spine X-ray showing marked osteopenia and compression fracture of the first lumbar vertebra led to findings of...
Original Article
Use of D-dimer and Lower Extremity Doppler Ultrasound Results to Obviate the Need for Computerised Tomographic Pulmonary Angiography
The diagnosis of pulmonary embolism (PE) can be a challenging problem. It depends on clinical suspicion and the interpretation of a combination of clinical and radiological presentations.
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Original Article
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Radiofrequency (RF) ablation for the treatment of focal liver malignancies is a relatively new image-guided procedure that is gaining increasing acceptance in the radiologic and surgical community, particularly as an alternative treatment option for patients who have inoperable tumours. The potential benefits of minimally invasive image-guided ablation, as compared...
Others
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 the literature on Medline revealed very few reports on infective keratitis caused by N. meningitidis.
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Others
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. Prior to this episode, he was well and not known to have any major illnesses.
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Others
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 results from central retinal artery occlusion or optic neuropathy from direct compression or from compression of optic nerve venous drainage.
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Others
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 ages with an overall perinatal mortality rate (PNMR) of 86.6%. If the diagnosis is made before 24 weeks’ gestation, the PNMR is 95%, with 30%...
Others
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 segments of the eye secondary to an infectious agent, is an uncommon but devastating complication.
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Editorial
Building Collaboration in Cardiac Imaging
Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery disease (CAD) detection has captured the imagination of the public appears exceptional.
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Others
3rd FY Khoo Memorial Lecture – Education, Professionalism, Outsourcing and the Future of Radiology
Radiology is undergoing unprecedented changes. Not only is the technology evolving rapidly, providing images of breathtaking anatomical clarity, but functional information has also become a reality.
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Others
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 clinically significant irregular and asymmetric corneal changes.
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Others
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 colorectal cancers, but also because it implies a poor prognosis. We discuss 3 patients with rectal adenocarcinoma who subsequently developed cutaneous metastases.
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Others
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 estimated incidence of 1 in 350,000 in a newborn screening programme.
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Review Article
Singapore National Medical Image Resource Centre (SN.MIRC): A World Wide Web Resource for Radiology Education
Radiological images are critical for diagnosis, teaching and research. In radiology education, learners must be exposed to large amounts of visual information, and assimilation of these medical images is essential in the training of diagnostic skills.
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Review Article
Teleradiology in Singapore – Taking Stock and Looking Ahead
Teleradiology is the electronic transmission of radiologic images from one location to another for the purposes of interpretation and/or consultation. The current interest in teleradiology is fuelled mainly by rapid technological advances, a worldwide shortage of radiologists, and cost considerations in developed countries.
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Others
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 (CHB) are the commonest cause. Hence, in Singapore where 4% of the population are hepatitis B carriers, when faced with acute hepatitis in a patient...
Others
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 with suspected thyrotoxicosis. These indices give sufficient information regarding the functional status of the thyroid gland under most circumstances.
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Others
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 treatment of opioid dependence in Singapore and other countries. Buprenorphine is available in primary care clinics and can be prescribed by all licensed physicians who...
Others
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 entity became more frequent after the introduction of vasoactive drugs for intracavernosal injections.
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Original Article
Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore
Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection from close contact.
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Others
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 day before the rash started.
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Others
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 consume people from within with its symptoms of bloody cough, fever, pallor and long relentless wasting) as the most widespread disease of the times, which...
Others
Necrotising Fasciitis and Traditional Medical Therapy – A Dangerous Liaison
The first case was a 54-year-old lady, with a history of insulin-dependent diabetes mellitus and hyperlipidaemia, who presented with bilateral hand pain and stiffness of 4 days’ duration.
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Others
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 and non-caseating epithelioid granulomas in affected organs.
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Others
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 interests. Because of this, and because of its rarity, it has received little attention in the literature.
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Others
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 agent of this disease in 1882 led to the acceptance of “Koch’s postulates,” which remain the gold standard for linking a pathogen to a disease.
This...
Others
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 been disappointing.
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Others
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 a patient can be life threatening.
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Others
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 case of postirradiation sarcoma of the sphenoid bone after radiation therapy for nasopharyngeal carcinoma.
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Others
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. Staphylococcus aureus is the commonest cause of septic arthritis and various series reported rates of 17% to 80%.
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Others
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 pregnancy. There was no history of consanguinity and no family history of multiple pregnancies. In the current pregnancy, there was no maternal illness, history of...
Others
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 adjacent intra-thoracic structures. Examples include Ortner’s syndrome due to compression of the left recurrent laryngeal nerve, and dysphagia from oesophageal compression. We report 2 unusual...
Others
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 her right temporal region. There was no loss of consciousness, visual disturbances or motor dysfunction after the fall. She had symptoms of vomiting a few...
Others
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 or extraluminal. They typically occur in the periampullary region, along the medial aspect of the second and third part of the duodenum. Periampullary diverticula (PAD)...
Others
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 in various extrapulmonary locations.1 Although abdominal IMTs have been reported, retroperitoneal tumours are exceedingly rare.1 Since needle biopsy and frozen section in these tumours are...
Others
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 occasional immediate intervention to avoid serious complications.
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Others
A Case of Cystic Schwannoma of the Lesser Sac
Schwannoma or neurilemmoma (NL) is a well-defined, usually benign, tumour arising from the nerve sheath (Schwann cell). It may present as a solitary mass in any part of the body, but is more commonly seen in the head and neck, the extremities and on the trunk.
This article is available...
Others
Developmental Dysplasia of the Hip: Universal or Selective Ultrasound Screening?
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Others
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 years earlier, and appeared to worsen in the preceding year. He had stuttered briefly in childhood, from the age of 5 to 11, but had...
Others
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 increasingly used instead of methadone in cessation programmes, as it is effective, well tolerated and has fewer side effects.1-3 In Singapore, according to Institute of...
Others
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 and skin. Other species of the Candida genusare occasional causative agents. Infections with other bacteria and dermatophytes can also occur. The infection is usually localised...
Others
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 by using high-frequency monopolar electrosurgical current via an ionised argon gas stream. When used endoscopically, a flexible probe passed through the accessory channel provides non-contact...
Others
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 serious systemic features, including fetal distress.1,2 Early recognition of this condition is of utmost importance as maternal and fetal well-being may be compromised due to...
Others
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 tomography (CT) imaging that detect metabolic anomalies via differences in tissue glucose uptake and thus metabolic activity.1-3 This may occasionally pose a problem in distinguishing...
Others
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 in Hong Kong and concluded that children should be discouraged to play in areas where snakes may hide and that protective footwear should be worn.4...
Others
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 of the internal jugular vein (IJV), leading to metastatic abscesses mainly of the lungs, but organs such as the liver, bones, joints and kidneys can...
Others
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 30 to 40 years after an acute poliomyelitis attack and is observed in approximately 25% to 28% of patients.1 It is still unclear, at this...
Others
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, such as bone disease, renal disease, or hypercalcaemic crisis, in contrast to the relatively asymptomatic presentation of benign parathyroid disease.2 Problems encountered include difficulty in...
Others
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 lesion possessing relatively high recurrence and progression rates. We report a case of this neoplasm, manifesting initially with gross haematuria and haematospermia, and subsequent acute...
Others
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 sinus syndrome has been described in immunosuppressed patients.
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Others
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 6 cycles.
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Others
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 bone tumours. Mucoceles can erode through the surrounding bone and spread both intraorbitally and intracranially.1-4 We report an unusual case of a patient with intracranial...
Others
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 Table 1. All 3 patients were previously well, without any underlying diabetes mellitus, renal or hepatic diseases, and none was on any immunosuppressants. None of...
Others
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 found in male transplant patients and not seen in children with renal transplant. Two Chinese renal transplant recipients who developed sebaceous hyperplasia while on cyclosporin...
Others
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 prostatectomy incontinence1 and in children with neurogenic voiding dysfunction usually secondary to spinal dysraphism.2 However, it is rarely used in adults with neurogenic stress incontinence...
Others
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 structures which are normally managed in an Otology practice. However, in duplication anomalies, clinical features are varied and may include those seen in a typical...
Others
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 presented as a hard and progressively enlarging breast mass.
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Others
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 from 16% to 38%.1-4 Recurrence, even after seemingly complete resection, is common, occurring in 23% to 85% of patients.3,5,6 The reported mean disease-free interval ranges...
Others
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 years, with an episode of depression and mania that started 40 years ago, and then 3 episodes of mania in the past 6 years. About...
Others
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 sizes in the jaw. Unicystic ameloblastoma often presents as a large unilocular radiolucency in young individuals, typically at the posterior mandible, and is usually associated...
Others
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 scar. The most probable mechanism through which this can occur is invasion of the myometrium through a microscopic tract. The tract is believed to develop...
Others
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 15% in endemic areas.1 It carries a mortality rate of as high as 40%.2 The majority of TB infection have occurred within 12 months of...
Others
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 paradigm that nothing can be done leaves little hope for such patients as restoration was once considered impossible.
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Others
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 earlier literature on pregnancy in PXE contained reports of severe complications, most patients show no serious complications during pregnancy.
This article is available only as a...
Others
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 such as pegaptanib (Macugen, EyeTech/OSI Pharmaceuticals) and ranibizumab (Lucentis, Genentech) are Food and Drug Administration (FDA)-approved in the US for the treatment of neovascular AMD.
This...
Others
Magnetic Resonance Imaging of Sports Injuries of the Knee
Sports-related knee injuries are common, with contact sports and sports involving twisting movements being the most frequent causes. Sports injuries may affect any of the knee structures, including ligaments, menisci, bones, cartilage and periarticular soft tissues.
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Others
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 defect in the thoracic enclosure. According to aetiology, pulmonary hernias can be congenital (due to rib or intercostal hypoplasia or agenesis) or acquired (traumatic, pathological...
Others
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, especially among children. The severity of the envenomation is related to haemodynamic and cardiorespiratory alterations, with cardiac failure and cardiogenic pulmonary oedema being the major...
Others
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 past 5 years.
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Others
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 often associated with hormone replacement or tamoxifen.
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Original Article
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian countries.
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Others
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 cuff tears, impingement syndromes, tendonitis, bursitis, adhesive capsulitis, acromioclavicular joint osteoarthritis, as well as cervical pathology such as disc disease and spondylosis. Suprascapular nerve neuropathy...
Others
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. A growing number of authors have reported the use of endovascular stenting as treatment for mycotic aneurysms. To our knowledge, this is the first case...
Others
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 growth more frequently than any other systems during pregnancy. Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy, lactation or 1-year postpartum. The...
Others
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 used as an adjunct to manage intractable opioid dependence. Buprenorphine, a partial opioid agonist, has been shown in previous trials to reduce heroin use, with...
Others
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. On the other hand, it may simply represent a benign adrenal adenoma with no prognostic implications. In a cohort of lung cancer patients, an isolated...
Others
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 congenital heart lesions). In Singapore with a live birth of over 37, 000 per year,1 the expected number of new TOF cases will be approximately...
Others
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 other sites.3,10-14 Various terms applied to this tumour reflect its histological diversity.1-3,9 The recognition and consequent reporting of this neoplasm increased significantly after the report...
Others
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 myocardial infarction (STEMI).1 Thrombosis of the atherosclerotic coronary artery is by far the most common cause of acute myocardial infarction. In patients without traditional risk...
Others
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 not without complications.1 One complication is that of aneurysmal dilatation, which can cause rupture and potentially fatal haemorrhage.
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Others
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 in 9459 clinical and laboratory-confirmed dengue cases in 2004 and up to 13,653 cases in its 2005 dengue epidemic.2
This article is available only as a...
Others
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 reported to be 6% in a series of 457 patients with SAH.2 However, the diagnosis of NPO can be challenging when it occurs without abnormal...
Others
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 of intracellular metabolites. Hyperuricaemia from breakdown of large amount of nucleic acids in lysed tumour cells causes renal dysfunction from precipitation of uric acid leading...
Others
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 the acronym in 1980.1 With a wide array of features, this condition can present to a variety of medical subspecialties. We report a patient who...
Others
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 but was switched to FVIII concentrate in 1995. He first developed FVIII inhibitor in 1995 and his inhibitor level fluctuated between 0.3 and 2 BU....
Others
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 those of Western Europe and those of the rest of Asia, accounting for 5.4% of all female cancers diagnosed between 1998 and 2002 in Singapore.1...
Letter to the Editor
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, the US Food and Drug Administration (FDA) approved the drug as a treatment for erythema nodosum leprosum. The finding of increased angiogenesis in myeloma, coupled...
Others
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 of the uterus. As a result, there is no clear plane between the placenta and the underlying uterus to which it is implanted. The extent...
Others
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 and uveitis.1 In one study, cystoid macular oedema contributed to 37.9% of low vision in patients with retinal vein occlusion.2 Persistent macular oedema may lead...
Images in Medicine
Paediatric perineal skin pit: More than skin deep?
A 2.5-year-old boy was referred to our clinic for abnormal genitalia and a febrile urinary tract infection (Escherichia coli >105 colony-forming units/mL). At birth, his parents were informed that he had a “bilobed scrotum and a deep perineal skin pit” that may pose hygiene and cosmetic issues. They had...
Others
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 the living).1 Placebos were fake substances or rituals used by medieval physicians to “please” patients for whom no cure was available. Arguably, acceptable uses for...
Others
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 year. Toddlers form the most vulnerable group. Swallowed objects may be true foreign bodies such as coins, plastic toys, bones, pins and disc batteries.1,2 The...
Others
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 descending aorta. He was found to have arterial deoxygenation when supine, that improved in the erect position.
This article is available only as a PDF. Please...
Others
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 defining this broad disease spectrum which accounts for 4% to 16% of SLE mortality and may affect as many as 90% of SLE patients.1 They...
Others
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. We report angioedema as the initial presentation that led to a diagnosis of SLE in a middle-aged female.
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Letter to the Editor
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 traffic accidents and falls from heights. The reported incidence of peripartum pubic separation varies from 1 in 300 to 1 in 30,000 deliveries,1,2 although it...
Others
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 occur. If functionally active auditory fibres survive and there are no signs of recurrent tumour, we believe that successful rehabilitation is possible with a cochlear...
Others
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 the costal margin. Computed tomography (CT) scan of the abdomen showed a large heterogeneous mass in the right lobe of the liver, and she underwent...
Others
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 chronic pain. This suggests the importance of suppressing the sensitisation at the earliest possible stages of the pain process.1 From this perspective, spinal cord stimulation...
Others
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 shown an increase among younger patients.1 The majority of patients present with lower urinary tract symptoms, the most frequent of which is painless haematuria. Presentation...
Others
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 the a-globin gene cluster. The a-thalassaemia mutations usually involve deletions of one (-a) or both (--) a-globin genes, and are prevalent within Southeast Asia. In...
Others
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, gastrointestinal, cardiovascular or respiratory systems.1-4 It is an increasingly important emergency, notably in Western countries, especially among children.5,6 The age-sex standardised incidence of anaphylaxis was...
Original Article
Upper Limb Ischaemia – A Single Centre Experience
Upper limb ischaemia is an uncommon entity which presents less commonly as compared to lower limb ischaemia, and has a wide range of aetiology and controversies in preoperative investigations and management. Less than 2% of patients with upper limb ischaemia presents with rest pain, gangrene or ulcer.1 Although upper...
Others
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 our knowledge, a chronic subluxation of the os odontoideum resulting in cervical myelopathy has yet to be described in a child with the Beare-Stevenson cutis...
Others
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 that damage the occipital cortex, postgeniculate pathways or both.1 This leads to the impairment in basic functions, such as reading, visual search and navigation. Thus,...
Images in Medicine
A Tiny Stone Induced Ureteral Rupture
A 60-year-old previously healthy man with unremarkable medical history presented with a complaint of intractable flank pain for one day. The laboratory test results were within normal limits except for microscopic haematuria on urinalysis.
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Original Article
Evaluation of Data Completeness of the Prostate Cancer Registry after Robotic Radical Prostatectomy
Cancer data can be abstracted manually by cancer registrars or extracted automatically from the electronic medical systems. There may appear to be nothing in common between a manual Cancer Registry dealing with a few hundreds of new cases a year, and a large, highly computerised Cancer Registry as both...
Letter to the Editor
Medical Misadventure: Barium Extravasation in Colorectal Cancer
Double contrast barium enema (DCBE) is a safe and accurate diagnostic procedure for colorectal cancer. It is often the next diagnostic test after incomplete colonoscopy, with an additional diagnostic yield of 3.2% for neoplastic lesions larger than 1 cm in the non-visualised portion of the colon.
This article is available...
Letter to the Editor
Management of Fournier’s Gangrene with Vacuum Assisted Closure® Dressing
Fournier’s gangrene is a surgical emergency. Treatment consists of fluid resuscitation, intravenous broad spectrum antibiotics and immediate surgical consultation with a view for early wound debridement and drainage.
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Original Article
Staging of Benign Prostate Hyperplasia is Helpful in Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostate Hyperplasia
Benign prostate hyperplasia (BPH), one of the most common diseases of ageing men, affects the quality of life by interfering with normal daily activities and sleep patterns. The current treatment options for patients with lower urinary tract symptoms (LUTS) suggestive of BPH mainly depend on the severity of the...
Others
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 results from impaired lymphatic transport leading to the pathologic accumulation of protein-rich lymphatic fluid in the interstitium, most commonly in the extremities.1 Lymphoedema may be...
Letter to the Editor
Durian Seed Masquerading as Gallstone Ileus on Computed Tomography
Bezoars and gallstones are unusual causes of small bowel obstruction, with well-described imaging features on CT. We present a case of intestinal obstruction caused by a laminated mass in the terminal ileum that resembled a gallstone on CT, but was surgically proven to be a durian seed phytobezoar.
This article...
Others
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 morbid and fatal complications associated with peritoneal metastases, especially in patients with liver cirrhosis and coagulation deficiencies, deserve renewed attention given recent advances in...
Original Article
Botulinum Toxin A for Idiopathic Detrusor Overactivity
Overactive bladder (OAB) is characterised by feelings of urgency to urinate, with or without incontinence and is usually accompanied by frequency and nocturia. These symptoms are due to involuntary contractions of the detrusor muscle.
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Original Article
A Survey of Local Preclinical and Clinical Medical Students’ Attitudes towards Radiology
Radiology is not a popular specialty for undergraduate student electives or postgraduate training amongst students from a local undergraduate medical school which is based in Southeast Asia. During the last 2 years (2007 & 2008), none of our elective students came from the local undergraduate medical school. During the...
Letter to the Editor
Primary Epithelioid Angiosarcoma of the Lung Presenting as Left-sided Shoulder Pain
Primary angiosarcoma of the lung is a rare, often difficult to diagnose disorder with non-specific respiratory manifestations. Angiosarcoma involving the lung is usually a result of metastatic disease.
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Others
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 by frequent relapses and admissions to hospital; the longest admission was for more than a year when she was 27 years old.
This article is available...
Letter to the Editor
Macronodular Tuberculosis: Imaging Resemblance of Cholangiocarcinoma
The ability of multiphasic computed tomography (CT) and magnetic resonance (MR) studies in the diagnosis of liver tumours such as hepatocellular carcinoma and cholangiocarcinoma is well established. Nevertheless, potential mimics of malignant tumours abound. Hepatic tuberculosis presenting as hepatic mass is rare and preoperative diagnosis is usually difficult without...
Letter to the Editor
Management of Thrombotic Thrombocytopenic Purpura in Metastatic Prostate Cancer with only Endocrine Therapy
Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that presents acutely with multiple organ failure. Although defined classically as a syndrome with a pentad of features, it is accepted now that a diagnosis can be made with the dyad of microangiopathic haemolytic anaemia and thrombocytopenia.
This article is available only...
Original Article
Incidence, Mortality and Five-year Relative Survival Ratio of Prostate Cancer among Chinese Residents in Singapore from 1968 to 2002 by Metastatic Staging
Prostate cancer is now the third most common cancer among Singapore males, with a world age-standardised incidence rate (ASIR) of 23.9 per 100,000 from 2003 to 2007. The average annual rate of increase between 1968 and 2002 was 5.6%, with a steeper increase seen in the last 10 years.
This...
Original Article
Central Clot Score at Computed Tomography as a Predictor of 30-day Mortality after Acute Pulmonary Embolism
Multi-detector Computed Tomography (MDCT) pulmonary angiography is currently the method of choice for the detection of acute pulmonary embolism (PE), because of its convenience, speed, sensitivity, direct clot visualisation and ability to provide alternative diagnoses that mimic PE clinically.
This article is available only as a PDF. Please click on...
Letter to the Editor
Renojejunal Fistula: An Extremely Rare Form of Renoenteric Fistula
Obstructive calculous disease of the kidney often results in infectious complications such as pyelonephritis and perinephric abscesses. Renojejunal fistula formation may occur as the inflammation becomes chronic.
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Others
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.
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Others
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, II, and aVF on admission to hospital. Subsequently, he developed sustained complete atrioventricular block with no ventricular escape which necessitated temporary pacing.
This article is available...
Others
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 common in blunt traumatic injuries, However, epicardial injuries and atrial ruptures are common findings in deaths due to falls. Literature reveals that cardiac injury should...
Letter to the Editor
Sustained Clinical Efficacy after Repeat Intradetrusor Botulinum Toxin Type A in the Treatment of Neurogenic Detrusor Overactivity
Despite the introduction of more potent and uroselective antimuscarinic agents, many patients with neurogenic detrusor overactivity still suffer from refractory incontinence. Intradetrusor botulinum toxin injections had been shown to be safe and effective in treating such patients who had failed medical therapy.
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Others
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 the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...
Others
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 cancers and disease in general. However, remarkably and almost curiously, there has been no monozygotic twin-pair concordant for clear cell renal cell carcinoma (ccRCC) reported...
Original Article
Cone Beam Computed Tomography for Vascular Interventional Radiology Procedures: Early Experience
Cone beam computed tomography (CBCT) is a relatively new technological innovation which utilises flat-panel detector technology to obtain CT-like axial images. The radiation source beam and flat panel detector are coupled together by a C-arm. In a single 180-degree rotation of the C-arm (Fig. 1), a typical CBCT unit...
Others
Neonatal Ovarian Cysts: Role of Sonography in Diagnosing Torsion
Simple cysts are commonly seen in neonatal ovaries. Majority of them are small and resolve spontaneously. Complications such as torsion and haemorrhage rarely occur, but when they do, they may cause symptoms due to mass effect such as bowel or urinary obstruction. Sonography plays an important role in diagnosis,...
Others
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 vertebrae. The transpedicular short-segment construct represents an attempt to rebuild the anterior column without the need for anterior strut graft or plate fixation, hence, avoiding...
Others
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 treatment for primary permanent vascular access in patients with kidney failure. A native arteriovenous fistula is now widely accepted as the vascular access of choice...
Review Article
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 as multidrug-resistant or MDR-TB), but also to at least 1 of 3 injectable second-line agents (amikacin, kanamycin or capreomycin) and to any fluoroquinolone. XDR-TB is...
Original Article
Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study
Mammogram has been the gold standard for breast cancer screening and Magnetic Resonance Imaging (MRI) has been advocated for screening of high- risk individuals. However, there is currently no recommendation for supplementary ultrasound scan in breast cancer screening. Moreover, it is known that dense breasts, which are common in...
Images in Medicine
Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?
A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron
emission tomography/computed tomography (PET/CT) for staging. Figure 1 demonstrates a whole body maximal intensity projection image while Figures 2 and 3 show cross-sectional images through the elbows...
Letter to the Editor
Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy—The Way Forward
I read with great interest the recent article published in the Annals of Academy of Medicine Singapore entitled, ‘Surgeon-Performed Ultrasound-Guided Fine Needle Aspiration Cytology (SP-US-FNAC) Shortens Time for Diagnosis of Thyroid Nodules, Ann Acad Med Singapore 2014;43:320-4’. Indeed, ultrasound-guided fine-needle aspiration (US-FNA) is an exceptionally valuable and simple approach...
Original Article
Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms
Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS) that affect quality of life and it causes structural and functional changes in the bladder. Previous clinical guidelines had emphasised on managing symptoms; however current...
Original Article
Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?
The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...
Letter to the Editor
A Follow-up Longitudinal Survey on a Cohort of Undergraduate Medical Students’ Attitudes towards Radiology
As a follow-up to an earlier study comparing the attitudes of first year undergraduate medical students following the introduction of a new radiology curriculum in 2008 with their clinical seniors who did not have an early exposure to radiology; we again surveyed this same cohort of first year students...
Commentary
Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging
Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit into various tissues and organs, the process invariably leads to organ dysfunction. Deposition of amyloid fibrils into the heart results in cardiac amyloidosis (CA). Manifestations...
Review Article
Managing a Renal Transplant Programme During the COVID-19 Pandemic: Practical Experience from a Singapore Transplant Centre
As infrastructure and policies were being put in place to combat COVID-19, we recognised that specialty-specific policies and protocols had to be drawn up as well. Similarly, the Renal Medicine Unit at the Singapore General Hospital, an academic medical centre, acted quickly to modify our services to (1) protect...