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. This article is available only as a PDF. Please click on...

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. This article is available only as a PDF....

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists have, whenever possible, adopted the practice of early extubation after cardiac surgery to improve the patient’s level of comfort and to allow an early return...

It is known that exposure of animals and humans to heavy metals such as lead can result in neurological dysfunction. Pharmacodynamic effects of lead (Pb++) on tension of smooth muscles, interaction with catecholaminergic function and neuromuscular transmission have been described. This article is available only as a PDF. Please click...

Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...

Colour image analysers have been extensively used in medical research since 1970 for histomorphometric studies. Image analysis gives more information and a better understanding of relative morphological changes in histological tissue sections. This is especially pertinent when different morphological areas are immunohistologically stained and present in contrasting colours or...

The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections, combined with injections to outline the blood supply. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Metastatic spread is the principal reason of treatment failure in solid tumours. Surgery, radiation therapy and chemotherapy have not manifestly altered the prognosis for metastatic tumours. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Bacterial infections are devastating and potentially lethal complications of acute pancreatitis, responsible for up to 80% of deaths in the condition. Pathogenetic studies of acute pancreatitis imply that the disease is initially a non-bacterial insult and that secondary sepsis frequently occurs during the progression of pancreatitis, concomitant with the...

From a historical perspective, the first experimental pancreatitis was induced by Claude Bernard in 1856 by the injection of bile and olive oil into the canine pancreatic duct, thus producing an acute necrotising pancreatitis. Since that time, acute experimental pancreatitis has attracted thousands of researchers, who employ animal models...

Despite intensive research and intervention, trauma continues to be the leading cause of death during the first three decades of life in the USA, and currently ranks as the fourth leading cause of mortality with over 160,000 deaths each year. Mortality following trauma occurs in three distinct periods. This article...

In the evaluation of any new cancer treatment, the use of appropriate experimental animal tumour models to bridge the gap between in vitro discovery and its eventual clinical testing is an important step. In vitro experimentation does not take into consideration the complex biological interplay among the host tissues,...

Hepatic fibrosis and cirrhosis of the liver are complex diseases which, in man, may be caused by such varied factors as alcohol, hepatitis, schistosomiasis, biliary atresia, malnutrition and exposure to carcinogens and hepatotoxins. Although hepatic fibrosis is characterised by the massive deposition of extracellular matrix components in the liver...

The development of the human biliary system has been studied extensively. This knowledge is essential to the understanding of the pathogenesis of a spectrum of diseases termed “ductal plate malformation” (DPM). This article is available only as a PDF. Please click on “Download PDF” on top to view the full...

The pancreatic islets of Langerhans were described by Paul Langerhans in 1869. They are distributed throughout the entire pancreas forming in adults approximately 1% of the pancreatic mass. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Hepatic stellate cells (HSC) are mesenchymal cells that are prominent in various forms of liver injury, in particular with cirrhosis or carbon tetrachloride-induced fibrosis. HSC are also being increasingly reported around and within hepatocellular cancers (HCC), and have been thought to be responsible for the capsule formation in these...

Allogeneic tissue and organ transplantation has long been an important medical issue, as it provides an effective treatment alternative for a broad spectrum of medical problems. It is essential to establish the animal models used for a specific type of allogeneic tissue or organ transplantation prior to its clinical...

Hypoxic tissue injury is not only caused by lack of oxygen as was previously believed. Now it is clear that tissue injury associated with hypoxia occurs to a large extent in the post-hypoxic reoxygenation period. This article is available only as a PDF. Please click on “Download PDF” on top...

Although a number of data support the notion that mast cell (MC) degranulation Is an important component of the tissue response elicited by ischaemia-reperfusion, the role of the gastrointestinal MC system in the pathophysiology of postischaemic mucosal barrier lesions is still poorly understood. The mucosal MCs (MMCs) of the...

Primary hepatocellular carcinoma (HCC) is one of the commonest cancers in some parts of the world including several areas in China. The geographically distinct distribution of HCC indicates there are some special factors which play key roles in hepatocarcinogenesis. This article is available only as a PDF. Please click on...

Hepatocarcinogenesis is a multistage and multifunctional process. Epidemiological studies indicate that contamination of food with aflatoxin B, (AFB,) and chronic infection with hepatitis B virus (HBV) are the major risk factors for human primary liver cancer. This article is available only as a PDF. Please click on “Download PDF” on...

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. This article is available only as a PDF....

Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis of osteoarthritis. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Allograft transplantation of bone has been established as a viable and useful reconstructive procedure when limb salvage is the option of choice. For bone allografts, this is thought to be due to the relatively avascular structure and that low-freezing or freeze-drying for periods beyond three months reduces cellular immunogenicity. This...

The direct intraluminal (IL) administration of drugs into the intestine may have an important regional action and therefore clinical implications in the effective management of functional bowel disorders. We have previously published findings in the anaesthetised in vivo pig, that cisapride and mebeverine when infused IL into the sigmoid...

Liver transplantation (LTx) is the treatment of choice for many patients with end stage liver disease. However liver allograft availability prevents its widespread application. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Bridging a vertebral gap in the spine is one of the commonest problems facing the spine surgeon after dealing with a tumour, infection or a fracture. The gold standard today is still the autogenous graft, though other solutions are the allograft, bone cement fashioned as a block, ceramics and...

Blood pressure is an important parameter commonly measured in experimental studies using animal models. Various non-invasive techniques to monitor blood pressure have been described in the literature but most of these are applicable only to small animal models like the rat. This article is available only as a PDF. Please...

Articular cartilage injuries to the knee are commonly seen by team doctors, sports physicians and orthopaedic surgeons. Despite many clinical as well as experimental studies on the healing of such defects, the ability to regenerate mature hyaline cartilage capable of withstanding daily functional stresses in the knee remains a...

Although the lung is mostly referred to as a respiratory organ it also exhibits a variety of metabolic functions, e.g. uptake, storage and/or synthesis and metabolism of compounds as different as biogenic amines, prostaglandins and angiotensin I. In spite of this vast metabolic capacity and the respiratory role of...

The application of the experimental approach to Science and Medicine has its roots in the 16th century. William Harvey (1578-1657), who demonstrated the passage of blood through the veins unidirectionally towards the heart as evidence for circulation of blood, was generally credited as one of the earliest physicians who...

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...

Atrial septal defect (ASD) forms the commonest grown up congenital heart diseases seen in cardiac surgical practice. Repair of this has become so safe that the emphasis now is on cosmetic outcome. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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. This article is available only as a PDF. Please click on “Download...

Congestive heart failure (CHF) is a leading cause of cardiovascular morbidity and mortality. This syndrome tends to run a chronic course with a wide spectrum of compensatory physiological and neurohormonal mechanisms that may be maladaptive in the terminal phase of the illness. This article is available only as a PDF....

The management of aortoiliac occlusive disease has been evolving in the past few decades. Surgical options include aortofemoral bypass, endarterectomy, extraanatomical bypass and endovascular intervention. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the last two decades. Gastric bleeding, ischaemic bowel disease, gallbladder disease, and pancreatitis are reportedly the most common complications. This article is available only as a PDF....

Minimally invasive techniques are increasingly being used in cardiac surgery. In particular, coronary artery bypass grafting (CABG) and mitral valve surgery are now often done using a limited approach to the heart. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

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

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. This article is available only as...

Atrial fibrillation is the most common sustained cardiac arrhythmia. The overall prevalence of atrial fibrillation is 0.4%. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial were the impact of changing demographics and disease patterns, the importance of optimising resources, and the need for structured training and sub-specialisation. This article is available...

The use of deep hypothermic circulatory arrest (DHCA) as a method of cerebral protection during aortic surgery was first described in 1975. Its use is based on 2 fundamental concepts. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well with underlying and accompanying diseases and invasive monitoring. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Pulmonary artery catheter is widely used in cardiovascular surgical practice. Various complications of the Swan-Ganz catheter during insertion, its long-term placement, or removal are well known since its introduction. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

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...

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

Percutaneous coronary intervention (PCI) is the preferred therapy strategy for revascularisation in the case of an acute coronary syndrome (ACS) or acute myocardial infarction (AMI). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Dear Editor, Reoperation for mitral valve re-replacement in patients with patent coronary bypass grafts can be a formidable task in the elderly. We report a patient that was successfully treated using a novel minimally invasive approach via the apex of the left ventricle. This article is available only as a PDF....

Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram that offers no information on the functional significance of a coronary lesion. It is difficult to define the haemodynamic significance of a stenosis from the...

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of AF,1 which increases with age, is 8% in people aged over 80. About three-quarters of the cases are non-valvular AF. The risk for stroke in...

Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous PVL closure has become increasingly performed and is an alternative to surgery.1 PVLs occur more frequently after transcatheter aortic valve implantation (TAVI), as the transcatheter...