Editorial
Evolving therapies for atopic dermatitis: Bridging guidelines and practice
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterised by dysregulated type 2 immune responses, skin barrier dysfunction and intense pruritus (itching). The disease burden of AD is substantial, affecting at least 171 million individuals worldwide in 2019, representing 2.23% of the global population.1 Among skin diseases,...
Letter to the Editor
Traction alopecia in women: An under-recognised cause of hair loss
Dear Editor,
Alopecia ranks among the most common clinical complaints encountered by dermatologists.1 In particular, affected women often experience great psycho-emotional stress leading to a reduction in quality of life.2
We conducted a prospective epidemiological study conducted over 77 weeks from 1 August 2022 to 23 January 2024 at an outpatient...
Letter to the Editor
HLA-B*5801 testing: Is it time to consider mandatory testing prior to prescribing allopurinol in Singapore?
Dear Editor,
Stevens-Johnsons Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe, life- threatening mucocutaneous reactions that most commonly occur as drug-related reactions.1 In recent years, several risk factors for the develop- ment of SJS/TEN, such as genetic factors, have been identified. Notably, carriers of the HLA-B*5801 and HLA-B*1502 alleles ...
Commentary
The potential of RNA therapeutics in dermatology
Graphic design by Liu Yujia
Ribonucleic acid (RNA) therapeutics involving, among others, microRNAs (miRNAs), small interfering RNAs (siRNAs) and/or antisense oligonucleotides (ASOs) hold great potential for the advancement of medical treatments in dermatology.
First, there are now novel ways to treat several dermatological conditions where existing treatments have been largely unsatisfactory....
Commentary
Call for a Singapore National Action Plan for Sepsis (SNAPS): Stop sepsis, save lives
Sepsis is a life-threatening organ dysfunction syndrome caused by a dysregulated host response to an infection.1 It affects up to 48.9 million people globally every year and causes 11 million sepsis-related deaths, accounting for 1 in every 5 deaths worldwide.2 The huge disease burden leads to significant consumption of...
Review Article
AL amyloidosis: Singapore Myeloma Study Group consensus guidelines on diagnosis, treatment and management
Amyloidosis refers to disorders characterised by the deposition of insoluble amyloid fibrils, which are pathogenic,1 resulting in organ dysfunction. Amyloidoses differ in the protein precursor undergoing aggregation and downstream target organs implicated. Consequently, clinical manifestations are varied, from localised amyloidosis in Alzheimer’s disease, to systemic amyloidosis such as immunoglobulin...
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...
Editorial
Improving management of AL amyloidosis
In this issue of the Annals, Tan et al. on behalf of Singapore Myeloma Study Group presented the consensus guidelines on light chain (AL) amyloidosis.1 This is an encouraging effort as AL amyloidosis is a rare disease, with diagnostic and therapeutic challenges. A comprehensive review examining its pathophysiology, diagnostic...
Letter to the Editor
Outcomes of nurse-led cryotherapy treatment for viral warts
Dear Editor,
Cryotherapy is a cost-effective treatment that can be performed by non-dermatologists for viral warts, which are very common.1,2 The National University Hospital, Singapore runs a nurse-led wart clinic where nurses are trained to administer cryotherapy. This study reviewed eradication rates and side effects in patients treated at the...
Editorial
Incorporating assessment of fibrinogen gene polymorphisms and bleeding risk in patients treated with direct oral anticoagulants
Direct oral anticoagulants (DOACs) have become entrenched as the dominant anticoagulant over the last decade for patients with venous thrombosis and atrial fibrillation.1 Compared to warfarin, bleeding risk is similar or lower for patients on DOACs but clinically relevant bleeding is still a risk, especially for patients with impaired...
Letter to the Editor
Rash characteristics of paediatric patients with COVID-19 in Singapore
Dear Editor,
Children with COVID-19 infection can present with a variable spectrum of clinical manifestations, and sometimes mucocutaneous manifestations can be the only manifestation of COVID-19 infection in children.1,2,3 We report 4 cases of paediatric patients who had COVID-19 with mucocutaneous involvement, admitted to a tertiary children’s hospital in Singapore....
Images in Medicine
Lichen planus pemphigoides after pembrolizumab immunotherapy in an older man
An 84-year-old Chinese man with stage IV non-small cell lung cancer was initiated on pembrolizumab, an anti-programmed cell death (PD)-1 monoclonal antibody, 4 times per week. Seven weeks later, on the day of his third cycle, he developed a rash on his chest and right axilla, which subsequently resolved...
Review Article
Drug interactions between common dermatological medications and the oral anti-COVID-19 agents nirmatrelvir-ritonavir and molnupiravir
In December 2021, an Emergency Use Authorisation was issued by the U.S. Food and Drug Administration (FDA) for the use of the orally active antiviral medications nirmatrelvir-ritonavir (NMV/r, PAXLOVID) and molnupiravir (LAGEVRIO) in the treatment of patients with mild COVID-19, who are at risk of developing severe disease resulting...
Original Article
Characteristics of anti-transcriptional intermediary factor 1 gamma autoantibody-positive dermatomyositis patients in Singapore
Idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of acquired, systemic autoimmune conditions characterised by muscular and extramuscular manifestations. As a subset within the family of IIM, dermatomyositis is distinguished by cutaneous features and has twice the risk of associated malignancy than polymyositis.1-3
Various meta-analyses have shown that between 10%...
Editorial
Pharmacokinetic and pharmacogenomic considerations in managing use of nirmatrelvir-ritonavir and molnupiravir and dermatological treatments
The COVID-19 pandemic has been unprecedented in its impact on global health, economic, financial, psychosocial and political systems. The World Health Organization estimates approximately 627 million confirmed cases and 6.5 million deaths reported globally.1 In Singapore, the swift and prompt public health response of the government during the early...
Editorial
Idiopathic inflammatory myopathies: Not nearly the end of the road
The clinical spectrum of idiopathic inflammatory myopathies (IIM) has broadened over the past half century from a simple disease characterised primarily by muscle and skin manifestations, to a potentially life-threatening complex condition of multiple organ involvement. In the recent decade, the discovery and addition of novel autoantibody profiles including...
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...
Review Article
National surgical antibiotic prophylaxis guideline in Singapore
Surgical antibiotic prophylaxis (SAP) refers to the administration of antibiotics prior to clean and clean-contaminated surgeries to prevent postoperative surgical site infections (SSIs). An optimal SAP should be highly effective in preventing SSI. An ideal prophylactic antibiotic regimen is: (1) effective against pathogens—generally skin flora—most likely to contaminate the...
Images in Medicine
A man with bark-like skin
A 65-year-old Chinese man was admitted for evaluation of chronic anaemia. He had a history of hypertension and chronic kidney disease, and his regular medications were nifedipine and losartan. He was a retired cleaner who lived with friends and had no contact with his family.
He was referred to the...
Original Article
Impact of aortic annular size and valve type on haemodynamics and clinical outcomes after transcatheter aortic valve implantation
The management of severe aortic stenosis (AS) in patients with small aortic annulus (SAA) represents a therapeutic challenge due to the increased mortality and major adverse cardiac events (MACE) seen in this group of patients even after surgical aortic valve replacement (SAVR).1,2
In recent times, the role of transcatheter aortic...
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
Antiphospholipid and other autoantibodies in COVID-19 patients: A Singapore series
Dear Editor,
Thrombosis is an unexpected complication of COVID-19 initially reported in 3 patients from China.1 These patients tested positive for immunoglobulin (Ig) A anticardiolipin (ACA), IgG anti-β2-glycoprotein I antibodies (aβ2GPI) and IgA aβ2GPI, though not for the lupus anticoagulant (LAC).
In a Singapore study comprising 47,527 patients, 19 (0.04%) developed...
Letter to the Editor
Safety and efficacy of combined antiplatelet and low-dose rivaroxaban in patients with chronic limb threatening ischaemia in Singapore
Dear Editor,
Peripheral artery disease (PAD) is characterised by the debilitating atherosclerotic occlusion of arteries in the lower extremities, with chronic limb threatening ischaemia (CLTI) representing the most advanced stage of this disease process. Left untreated, these sequelae will invariably progress to major lower extremity amputation (LEA) and premature death....
Letter to the Editor
Haemoglobin H disease and outcomes in Singapore
Dear Editor,
Haemoglobin H (HbH) disease is a haemoglobinopathy affecting 3 of 4 α-globin genes on chromosome 16. It results from the deletion of 2 linked α-globin genes (α0-thalassaemia) on one chromosome and either a single α-globin gene deletion (--/-α) or non-deletional gene mutation (--/αTα) on the other chromosome. The...
Letter to the Editor
Change in hepatitis B virus DNA status in patients receiving chronic immunosuppressive therapy for moderate-to-severe skin disease
Dear Editor,
Hepatitis B virus (HBV) infection poses a global health burden. Clinically, patients may present with chronic HBV infection, occult HBV infection, and fulminant hepatic failure. In 2010, the hepatitis B surface antigen (HBsAg) seroprevalence in Singapore was 3.6%.1
Patients with dermatological conditions receive prolonged corticosteroid and other immunosuppressive therapy...
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).
This article is available only as a...
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
A Study of Idiopathic Thrombocytopenic Purpura (ITP) Patients over a Ten-year Period
Idiopathic thrombocytopenic purpura (ITP) is an immunoregulatory disorder in which antibodies damage platelets leading to their removal by cells of the reticuloendothelial system (RES). This occurs mainly in the spleen which is also the primary site of synthesis of these antiplatelet antibodies.
This article is available only as a PDF....
Others
Adjuvant Chemotherapy for Patients with Resected Dukes’ C and High-risk B2 Colon Cancer with Fluorouracil and Levamisole
Carcinoma of the large bowel is the second leading cause of cancer mortality in Singapore. Although the great majority of patients are discovered at a stage where resection with curative intent is possible, almost half of the patients afflicted will die of it.
This article is available only as a...
Commentary
Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer
Although great strides have been made in treating cancers, a significant number of patients still reach the point at which no curative treatment is available. Physicians then face the difficult task of informing patients that, although palliation is always possible, cure is not.
This article is available only as a...
Commentary
Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia
The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively.
This article is...
Commentary
The Polarprobe—Emerging Technology for Cervical Cancer Screening
Cervical cancer is a preventable disease that affects nearly half a million women worldwide. The Papanicolaou smear has been used for screening for over fifty years and the test has the advantage of fast and relatively easy sample collection.
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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.
This article is available only as a...
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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Review Article
Optimal Treatment in Gestational Trophoblastic Disease
Gestational trophoblastic diseases (GTD) encompass a spectrum of interrelated conditions:
Hydatidiform mole (HM)
Invasive mole (IM)
Choriocarcinoma (CC)
Placental site trophoblastic tumour (PSTT)
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Review Article
Fallopian Tube Carcinoma—A Review
Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847.
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Review Article
Current Management of Early Vulvar Cancer
Carcinoma of the vulva is an uncommon malignancy, but one that is amenable to early diagnosis if symptoms and signs are appropriately investigated. Although patient and physician delay remains common, an increasing number of patients are being diagnosed with early stage disease.
This article is available only as a PDF....
Review Article
Topoisomerase-I Inhibitors in Gynaecologic Tumours
Topoisomerases are essential nuclear enzymes with a multiplicity of cellular functions involving DNA replication, RNA transcription, mitosis, and chromosome condensation. Two classes have been identified: the class I topoisomerases, named “I” because they induce single-strand breaks and reunions of the DNA double helix, and the class II topoisomerases, named...
Review Article
Screening for Ovarian Cancer
Ovarian cancer is the most common gynaecological malignancy with over 5000 new cases diagnosed every year in the UK and 22 000 in the United States. Four thousand women die each year of ovarian cancer in England and Wales, and 13 000 die in the USA.
This article is available...
Review Article
Biomarkers in Carcinoma of the Cervix: Emphasis on Tissue-related Factors and Their Potential Prognostic Factors
Accurate staging is of utmost importance in determining the prognosis of carcinoma of the cervix. Demographic features such as race and socio-economic status have been demonstrated as not having significant influence.
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Review Article
The Management Dilemma of the Mildly Abnormal Smear: Fact or Fiction?
Carcinoma of the cervix is still a relatively common gynaecological malignancy. However, despite being potentially preventable it still claims the lives of many women even in those countries where organised screening programmes exist.
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Review Article
Adenocarcinoma of the Cervix
It is clear from studies in Canada, Scandinavia, and more recently the United Kingdom, that routine Pap smear screening has not only reduced the incidence of squamous carcinoma of the cervix but indeed in the last 10 to 15 years has halved the mortality rate from this disease. In...
Original Article
Malignant Ovarian Germ Cell Tumours: Experience in the National University Hospital of Singapore
One of the most remarkable advances in the management of gynaecological cancers is in malignant ovarian germ cell tumours. Before the early 70s, some of the malignant ovarian germ cell tumours had a notoriously bad reputation in terms of aggressiveness and poor prognosis.
This article is available only as a...
Original Article
A Phase II Study of Combined CPT-11 and Mitomycin-C in Platinum Refractory Clear Cell and Mucinous Ovarian Carcinoma
Platinum resistance, either de novo or acquired, is a major obstacle in the treatment of advanced ovarian cancer. Platinum-resistance has been classified into the following three categories; (1) primarily (intrinsically) platinum-resistant disease: tumours showing no change (NC) or progressive disease (PD) while on initial platinum-based chemotherapy; (2) secondarily platinum-resistant...
Original Article
Single Agent Paclitaxel in Resistant and Relapsed Epithelial Ovarian Cancer After First-line Platinum-based Chemotherapy—Experience in an Asian Population
Ovarian carcinoma ranks fourth among causes of death in women and is the leading cause of death from gynaecological malignancies in Western countries. In Singapore, the incidence of this cancer has been rising for the last 25 years.
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Original Article
Uterine Papillary Serous Carcinoma—The KK Hospital Experience
Endometrial carcinoma comprises a morphologically heterogeneous group of tumours. Several authors during the 1960s and 1970s described an unusual variant of endometrial cancer containing psammoma bodies.
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Original Article
Radiotherapy as Local Adjuvant Treatment for Endometrial Carcinoma—A Review of 45 Patients
Radiotherapy as an adjunct to surgery has long been used in the management of endometrial carcinoma with the intent to improve local tumour control as well as to achieve excellent survival rates. Over the years, however, the specific role and relative benefit of postoperative radiotherapy for this particular cancer...
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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Original Article
The Surgical Management of Colorectal Complications from Irradiation for Carcinoma of the Cervix
Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma of the cervix, because radiotherapy is the principle mode of treatment for this fourth most common malignancy in women in Singapore (after carcinoma of the...
Original Article
Adjuvant Chemotherapy in “High Risk” Patients after Wertheim Hysterectomy—10-year Survivals
Wertheim radical hysterectomy has today become an accepted method of management of stage IB and early stage IIA cervical carcinoma, particularly in young patients in whom preservation of ovarian and coital function cannot be achieved if they were subjected to radiotherapy instead. However, a group of patients undergoing radical...
Original Article
A Review of Patients with High-risk Carcinoma of the Cervix Treated with Combined Surgery and Postoperative Radiotherapy
It is generally accepted that early stage invasive carcinoma of the cervix, stage I to stage IIA disease, can be treated with equal effectiveness with either radical hysterectomy or radical radiotherapy. However a proportion of patients treated with surgery may be classified as having a significant risk of relapse...
Original Article
Outcome of Early Cervical Carcinoma Treated by Wertheim Hysterectomy with Selective Postoperative Radiotherapy
Cancer of the cervix is the fourth most common cancer in females in Singapore after breast, colorectal and lung cancers. It forms 7.8% of all cancers in females for the period 1988 to 1992.
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Editorial
Gynaecologic Oncology—The Next Lap
Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all age groups: rhabdomyosarcoma in young girls, germ cell tumours in teenage girls and young women, cervical cancer in the middle age women, and epithelial ovarian...
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
Childhood Leukaemia: Towards an Integrated Psychosocial Intervention Programme in Singapore
In the last two decades there has been a surge of interest concerning the psychosocial correlates of life-threatening illnesses. Research in this area has focused especially on cancer and the possible link between immunology and psychological factors.
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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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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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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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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
One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore
Pityriasis rosea is a common, self-limited disorder of unknown but suspected viral aetiology, that develops abruptly with few or no prodromal symptoms. Classically, the first sign is the presence of a single lesion, 2 to 5 cm in diameter known as a “herald patch”.
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Original Article
Repigmentation of Vitiligo with Autologous Blister-induced Epidermal Grafts
Treatment of vitiligo can sometimes be difficult and disappointing. Medical treatment includes topical or systemic steroids and psoralen with ultraviolet A light (PUVA).
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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.
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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.
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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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Others
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
Concurrent Chemoradiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma of the Undifferentiated Type
Nasopharyngeal carcinoma (NPC) of the undifferentiated type has a unique geographic distribution and is rather different, biologically and aetiologically, from squamous cell cancer of the head and neck. This disease is of epidemiological concern in Singapore, with an age-standardized rate of 18.4 per 100,000 in Chinese males and 7.3...
Others
Retrospective Study of Behcet’s Disease seen at the National Skin Centre, Singapore
Behcet’s disease, first described by a Turkish dermatologist, Dr Hulusi Behcet, is a multisystem inflammatory disorder of unknown aetiology. The diagnosis of Behcet’s disease is based on clinical criteria because there are no pathognomonic laboratory features.
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Review Article
Newer Thrombolytic Agents
First-generation fibrinolytic agents (streptokinase and urokinase) are effective thrombolytic drugs, but are not fibrin specific as they also have the property to convert circulating plasminogen to plasmin when given at therapeutic doses. Because the plasminogen in the thrombus is in equilibrium with the plasminogen pool in plasma, the plasminogen...
Review Article
Cancer Gene Therapy—Fantasy or Foresight?
Genes define life, at least in its biological sense. The prospect of being able to manipulate human biological processes through genetic engineering understandably evokes a sense of excitement and omnipotence. Indeed, the birth of recombinant DNA technology in the 1970s immediately opened the floodgates for the successful manipulation of...
Original Article
A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens
Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been useful in diagnosis and treatment of certain cancers (as tumour markers) and many such antibodies have now been described.
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Others
8th Seah Cheng Siang Memorial Lecture: New Antithrombotic Agents
The tremendous interest in finding new anti-aggregating agents stems from the preeminent role that platelets play, not only in haemostasis and thrombosis, but also in atherogenesis and, be it less definitive, in arterial spasm. Compelling data from large-scale trials have established the role of platelet inhibitors in reducing coronary...
Others
3rd Yahya Cohen Lecture: The Role of the Myofibroblast-Like Cell in Hepatocellular Carcinoma—Host Defence?
It is indeed a great honour for me to be named the third Yahya Cohen lecturer and I would like to express my deepest thanks and appreciation to the Academy of Medicine Singapore for having selected me for this award. At this lecture, I would like to share with...
Others
1998 Runme Shaw Memorial Lecture: Somatic Evolution of Cancer
The interpretation of cancer as a somatic evolutionary process involving genetic mutation followed by selection, goes back to the early years of this century. Boveri’s hypothesis put forward in 1914 that cancer was associated with abnormalities of the chromosomes and Tyzzer and Strong’s experiments of transplantable tumours in 1916...
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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Others
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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Review Article
Prognostic Factors in Endometrial Carcinoma
In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of 72 per 100,000 women. In Singapore it is the third most common female genital tract cancer after cancer of the cervix and ovary.
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Original Article
Continuous Infusion 5-fluorouracil as Salvage Chemotherapy in Patients with Advanced Colorectal Cancer
Studies have shown beyond doubt that chemotherapy for metastatic colorectal cancer prolongs survival, impedes progression and stabilises disease. Compared with supportive care alone, it could also provide considerable benefits in terms of improved quality of life.
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Original Article
Activated Protein C Resistance: A Study Among 60 Thromboembolic Patients in the Singapore Population
In 1993, Dahlback and colleagues described a new hereditary thrombophilia state-activated protein C resistance (AK-R). Further studies showed this to be the commonest genetic cause of thrombophilia.
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Original Article
Use of Ligase Chain Reaction and Polymerase Chain Reaction on Urine Specimens to Detect Chlamydia trachomatis Infections in a Sexually Transmitted Diseases Clinic in Singapore
Infections caused by Chlamydia trachomatis are amongst the most common bacterial sexually transmitted diseases (STDs) in the world, causing substantial morbidity in young sexually-active people. C. trachomatis causes a variety of clinical syndromes in males (including urethritis and epididymitis), females (including cervicitis and pelvic inflammatory disease), and new-borns (including...
Commentary
Effect of Antiangiogenic Agents on Experimental Animal Models of Hepatocellular Carcinoma
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.
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Review Article
Murine Metastatic Tumour Models for Cancer Gene Therapy Research
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,...
Original Article
An Animal Model for the Study of Hepatic Stellate Cell and Hepatocellular Carcinoma Interaction
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...
Original Article
Synergistic Effect of Hepatitis B Virus and Aflatoxin B1 in Hepatocarcinogenesis in Tree Shrews
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.
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Original Article
The Expression of Insulin-like Growth Factor II, Hepatitis B Virus X Antigen and p21 in Experimental Hepatocarcinogenesis in Tree Shrews
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.
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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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Others
Retroperitoneal Castleman’s Disease in the Perinephric Space—Imaging Appearance: A Case Report and a Review of the Literature
Castleman’s disease (CD) was first proposed by Castleman in 1954. It is usually found in the mediastinum, but other sites have been described.
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Others
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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Others
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
Extended Resection of Locally Advanced (T4) Stomach Cancer
Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years, it is the third (10.1%) most common cancer in males and the fifth (6.5%) most common cancer in females in Singapore.
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Original Article
Granuloma Annulare: A Review of 41 Cases at the National Skin Centre
Granuloma annulare (GA) is a benign, inflammatory disorder of the skin that has no proven aetiology or widely accepted theory of pathogenesis. There are several clinical manifestations, ranging from localised GA, which is the commonest form and is characterised by erythematous or flesh-coloured papules in an annular arrangement, to...
Others
A Case Report of Erythema Induratum of Bazin’s Disease
There are many dermatological manifestations of tuberculosis, ranging from distinct entities such as tuberculosis verrucosa cutis, lupus vulgaris, scrofuloderma, to tuberculides. The term tuberculide is applied to any of a group of eruptions which arise in response to an internal focus of tuberculosis and clear with anti-tuberculosis therapy.
This article...
Others
Design of Phase I and II Clinical Trials in Oncology and Ethical Issues Involved
Drug development is costly and time-consuming in terms of economic, patient and research resources. An integrated effort involving academia, industry, and regulatory authorities is needed to ensure novel, effective therapies continue to be approved for clinical use.
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Letter to the Editor
Re: One-year Review of Pityriasis Rosea at the National Skin Centre, Singapore
I refer to a paper published in the Annals Vol. 28 No. 6 November 1999 titled “One-year review of pityriasis rosea at the National Skin Centre, Singapore” by Drs Y K Tay and C L Goh. I would like to point out that a prospective study on pityriasis rosea...
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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Others
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.
This article...
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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Original Article
Spectrum of Abnormal Mammographic Findings and Their Predictive Value for Malignancy in Singaporean Women from a Population Screening Trial
While screening mammography can detect early breast cancers, a significant proportion of asymptomatic women are subject to unnecessary workup and surgery when biopsies for abnormal mammograms are proven to be benign on histology. An accurate correlation between abnormal mammographic features detected on screening and their corresponding histology or predictive...
Others
Hereditary Breast Cancer: A Brief Overview
Worldwide, breast cancer is the third most common form of cancer, after lung and stomach cancer, and it is the most common form among women.1 The age-adjusted incidence rates of breast cancer are 176% higher in developed than developing countries.
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Others
Update of Genetics in Colorectal Carcinomas: Genomic Instability and Somatic Evolution
The hypothesis that carcinogenesis occurs through stepwise accumulation of mutations1 has now been generally accepted. However, there is continual dispute over how carcinogenesis can be achieved over the lifetime of an individual.
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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
Classical and Amyopathic Dermatomyositis seen at the National Skin Centre of Singapore: A 3-year Retrospective Review of their Clinical Characteristics and Association with Malignancy
Polymyositis/dermatomyositis is a connective tissue disorder with inflammatory muscle disease resulting in muscle weakness. When there is only muscle involvement, the term polymyositis is used.
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Original Article
Philadelphia Positive Acute Lymphoblastic Leukaemia (ALL): Clinico-Haematologic Characteristics, Molecular Analyses and 3-year Follow Up—A Single Institution Study
A number of specific chromosome abnormalities are associated with acute lymphoblastic leukaemia (ALL). The commonest in adults with B lineage ALL is the Philadelphia (Ph) chromosome t(9;22)(q34;q11).
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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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Original Article
Thrombotic and Haemorrhagic Complications in Patients with Mechanical Heart Valve Prostheses Attending the Singapore General Hospital Anticoagulation Clinic
Patients with mechanical heart-valve prosthesis receive lifelong anticoagulation. The management of these patients taking oral anticoagulants is aimed at achieving and maintaining adequate levels of anticoagulation to prevent thrombotic manifestations and at the same time to keep the risk of severe haemorrhagic complications to the minimum.
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Letter to the Editor
Systemic antibiotic prophylaxis for recurrent infective flares in children and adolescents with atopic dermatitis
Dear Editor,
Atopic dermatitis (AD) is a chronic inflammatory skin disease, affecting approximately 20% of children in Singapore.1 It is associated with skin barrier defects2 and increased skin colonisation with Staphylococcus aureus, which can trigger infective flares, especially in more severe disease. Strategies to reduce S. aureus colonisation and infection...
Others
Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding
Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in incidence of 3.68%. It comprises 22.8% of all local female cancers, with an annual mortality of 13.7 per 100,000 per year.
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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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Others
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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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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Others
Comparison of Allergic Contact Dermatitis Cases in the Private and Subsidised Clinics in the National Skin Centre, Singapore
Allergic contact dermatitis is a common clinical problem seen in our dermatology outpatient clinics, comprising 0.5% of patients seen in 1999. In addition to our contact dermatitis clinic and occupational dermatosis clinic which caters to subsidised patients, many patients have also been worked up and patch tested in the...
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...
Original Article
Malignant Melanoma Seen in a Tertiary Dermatological Centre, Singapore
Unlike in Caucasians, primary malignant melanoma is an uncommon skin malignancy in Singapore. There have been little published data on cutaneous melanoma in Southeast Asia.
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Original Article
A Retrospective Study of Incontinentia Pigmenti Seen at the National Skin Centre, Singapore Over a 10-year period
Incontinentia pigmenti, called Bloch-Sulzberger syndrome, is a rare X-linked dominant disorder involving ectodermal structures. It is a multisystem disorder with cutaneous, ocular, dental, cerebral and skeletal manifestations.
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Original Article
Treatment of Acute Promyelocytic Leukaemia Using a Combination of All-trans Retinoic Acid and Chemotherapy
Acute promyelocytic leukaemia (APL), or acute myeloid leukaemia (AML)-M3 under the French-American-British (FAB) classification, is characterised by the following: a distinct expansion of promyelocytes and immature myeloblasts in the bone marrow; balanced reciprocal translocation between the long arms of chromosome 15 and 17, t(15;17) which results in apposition of...
Original Article
An Audit of Patients with Rheumatic Disease Requiring Medical Intensive Care
Patients with rheumatic disease are often immunocompromised as a result of either their disease or treatment. They may become ill either from a flare of their autoimmune disease or from complications of treatment, at times requiring intensive care.
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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.
This article...
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.
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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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Original Article
A Retrospective Study of Melanocytic Naevi at the National Skin Centre
Melanocytic naevi are benign proliferation of melanocytes of congenital and acquired types which usually appear during adolescence or early adult life. Naevi are of three common subtypes i.e. junctional, compound and intradermal melanocytic naevi, with characteristic clinical appearance that aids in clinical diagnosis.
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Original Article
Antibiotic Sensitivity of Propionibacterium acnes Isolates from Patients with Acne Vulgaris in a Tertiary Dermatological Referral Centre in Singapore
In Southeast Asia, there have been few studies on the emergence of antibiotic-resistant strains of Propionibacterium acnes on the skin of patients with acne vulgaris. We previously reported the effect of short courses of antibiotics on the minimum inhibitory concentrations (MICs) of P. acnes.
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Original Article
Clinical Utility of Polymerase Chain Reaction in the Detection of Mycobacterium tuberculosis in Different Types of Cutaneous Tuberculosis and Tuberculids
Laboratory confirmation of cutaneous tuberculosis has remained difficult using conventional techniques which include the demonstration of acid-fast bacilli (AFB) on histopathologic examination and culture. In tuberculosis verrucosa cutis and lupus vulgaris which are paucibacillary, direct microscopy and tissue cultures lack the specificity and/or sensitivity for the detection of Mycobacterium...
Others
12th Chapter of Surgeons Lecture: Shifting Paradigms in the Management of Breast Cancer—A Surgical Perspective
The recorded history of breast cancer management spans four millennia. This story about breast cancer management is also one about change, about resistance to and acceptance of change.
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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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Review Article
CerbB2 Status in Breast Cancer: Pathologic Issues
The cerbB2 gene, also known as Her2/neu, encodes a transmembrane cell receptor with tyrosine kinase activity and epidermal growth factor receptor homology. All normal and the majority of breast cancer cells contain 2 copies of the cerbB2 gene and produce low levels of the corresponding protein.
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Original Article
CD4 Lymphocyte Enumeration in Patients with Human Immunodeficiency Virus Infection Using Three-Colour and Four-Colour Dual-Platform Flow Cytometry: An Inter-Laboratory Comparative Evaluation
Clinical flow cytometry provides a precise technology for the multiparameter analysis of the morphological (scatter) and immunofluorescence properties of stained leukocyte populations, as well as their percentages and absolute counts, at the single-cell level. Flow cytometry is commonly used for the identification of human lymphocyte subsets, a process referred...
Original Article
Deep Vein Thrombosis is Not Rare in Asia—The Singapore General Hospital Experience
Deep vein thrombosis (DVT), pulmonary embolism (PE), the postphlebitic syndrome and recurrent venous thromboembolism (VTE) are important and often preventable causes of early morbidity or death and of long-term disability in western populations. The reported annual incidence of VTE is about 2 per 10,000 persons in Scotland.
This article is...
Original Article
A Retrospective Study on the Characteristics of Androgenetic Alopecia among Asian Races in the National Skin Centre, a Tertiary Dermatological Referral Centre in Singapore
Androgenetic alopecia is hair thinning or balding due to the influence of androgens in males and females. Androgenetic alopecia is reported to affect 50% of the population by the age of 50 years in males and a decade later in females.
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Original Article
Cancer Incidence in Singapore, 1998 to 1999
The Singapore Cancer Registry has been monitoring the trends in cancer incidence since 1968. It publishes 5-yearly incidence figures for the periods 1968-1972, 1973-1977, 1978-1982, 1983-1987, 1988-1992 and 1993-1997.
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Original Article
High-dose Therapy followed by Autologous Haematopoietic Stem Cell Transplantation in Multiple Myeloma
Multiple myeloma (MM) is a disorder in which malignant plasma cells accumulate in the bone marrow and produce an immunoglobulin, usually monoclonal IgG or IgA. The incidence of MM in Singapore is 1 to 2 per 100,000 per year with a median age of 65 to 70 years at...
Review Article
New Aspects of the Blood Coagulation Cascade, Anticoagulants and Vein Thrombosis in Asia
Injury to blood vessels triggers haemostasis, a process that has evolved to achieve two superficially incompatible outcomes: arresting blood loss while protecting vessel patency and blood flow to distal organs. Contributors to haemostasis include subendothelial tissues and endothelial cells, blood platelets, tissue factor, plasma clotting factors and their physiological...
Others
A Review of Cutaneous Granulomas and Lupus Vulgaris Following BCG Vaccination in a Skin Hospital in Singapore
BCG vaccines are live vaccines derived from a strain of Mycobacterium bovis that was attenuated by Calmette and Guerin at the Pasteur Institute in Lille, France. In Singapore, all newborn babies are given the vaccination at birth, and until recently, a second vaccination was given to children at the...
Original Article
Efficacy and Tolerability of Irinotecan in Patients with Advanced Colorectal Cancer in Singapore
Colorectal cancer is the second most commonly encountered malignancy in the developed countries; in Singapore, it is the commonest cancer. With early detection, patients can be cured with surgery.
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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
The Epidemiology and Treatment of Anogenital Warts in Singapore: A Retrospective Evaluation
Anogenital warts are caused by specific subtypes of the human papillomavirus (HPV), of which serotypes HPV 6 and 11 are the most common. There are 3 types of HPV infection:
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Original Article
Sexually Transmitted Diseases in the Older Population in Singapore
Sexually transmitted diseases (STDs) in persons older than 50 years are rarely studied because STDs are more common in young people. There is very little published data focussing on this group of patients which is relevant to Singapore or this part of the world.
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Original Article
The Mastectomy Clinical Pathway: What Has It Achieved?
In an era of increasing healthcare cost and scarce resources, the tension between the cost and quality of healthcare demands not only effective but also cost-efficient healthcare systems.
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Others
Agreement or Prediction: Asking and Answering the Right Question
In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to the difference, in terms of the concepts as well as the practical usage, between analysing agreement and prediction.
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Original Article
Preliminary Experience in Radionuclide Therapy of Hepatocellular Carcinoma Using Hepatic Intra-arterial Radio-conjugates
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. In Singapore, the age-standardised incidence rate is 18.9 per 100,000 per year.
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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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Review Article
Idiopathic Thrombocytopenia in Pregnancy
Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder in which platelets are sensitised with an antiplatelet autoantibody and then destroyed by the reticuloendothelial system.1 Hence, it is also known as primary autoimmune thrombocytopenic purpura. There are two forms of ITP—acute and chronic.
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Review Article
Thrombophilia in Pregnancy
A clear understanding of thrombophilia is becoming increasingly important in the practice of high-risk obstetrics. In addition to their role in thromboembolic disease, there is increasing evidence linking thrombophilia and adverse pregnancy outcomes such as pre-eclampsia, intrauterine growth restriction, placental abruption and recurrent pregnancy loss.
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Review Article
Management of Haematologic Malignancies in Pregnancy
Malignancy complicates the course of about 1 in 1000 pregnancies and is the second leading cause of death in women of reproductive age. The most commonly diagnosed malignancies during pregnancy are breast cancer, cervical carcinoma, Hodgkin’s lymphoma and melanoma.
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Original Article
Pregnancy in Women with Idiopathic Thrombocytopaenic Purpura
Idiopathic thrombocytopaenic purpura (ITP) is the most common autoimmune haematological disorder in pregnancy. The pathophysiology of the disease is peripheral destruction of platelets mediated by antiplatelet antibodies.
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Others
Clinical Update on Deep Vein Thrombosis in Singapore
Deep vein thrombosis (DVT), and its acute complication–pulmonary embolism (PE), is one of the most important preventable causes of death in hospital patients. It also contributes to significant morbidity in terms of post-phleblitic syndrome and chronic venous ulcers.
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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
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous group of tumours.
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Original Article
Bullous Pemphigoid Seen at the National Skin Centre: A 2-year Retrospective Review
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder affecting mainly the elderly. It is characterised by autoantibodies to the basement membrane zone (BMZ), which are detectable on immunofluorescent studies.
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Original Article
Evaluation on the Use of a Portable Unit Versus the Laboratory for the Monitoring of International Normalized Ratio (INR) in Orally Anticoagulated Patients
Oral anticoagulation therapy is used for a number of conditions, namely deep venous thrombosis, pulmonary embolism, mechanical heart valves, embolic stroke as well as atrial fibrillation. Patients receiving this therapy are carefully monitored in order to maintain the intensity of anticoagulation in the appropriate therapeutic range.
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Letter to the Editor
Re: 188Rhenium-TDD-Lipiodol in Treatment of Inoperable Primary Hepatocellular Carcinoma—A Case Report
Hepatocellular carcinoma (HCC) is a common malignancy that is best treated by surgery. However, in the vast majority, surgery is not possible and alternative treatment options have to be attempted.
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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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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
Clinical Profile and Treatment Outcome of Livedoid Vasculitis: A Case Series
Livedoid vasculitis is a clinicopathological entity that has variously been referred to as atrophie blanche, livedoid vasculopathy or segmental hyalinising vasculitis. It presents with purpuric lesions and recurrent, painful ulcerations of the lower limbs which result in depressed, atrophic white scars.
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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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Others
A Case of Penicillamine-induced Dermopathy
D-penicillamine is a copper chelator used primarily in Wilson’s disease and cystinuria. Other long-term indications include rheumatoid arthritis, scleroderma and primary biliary cirrhosis.
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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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Review Article
Radionuclide Therapy of Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. It is a major cause of death from cancer in East Asia, especially China, Japan, Korea, Taiwan and Singapore, and sub-Saharan Africa, particularly Zimbabwe, Ethiopia and Mozambique.
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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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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...
Original Article
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point. Most QOL instruments are developed in English, although about one-fifth of the world’s population is ethnic Chinese.
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Review Article
The Molecular Biology of Peritoneal Carcinomatosis from Gastrointestinal Cancer
The term “peritoneal carcinomatosis” was first used by Sampson in 1931 to describe the intra-abdominal spread of ovarian carcinoma. Although ovarian cancers account for the majority of cases, peritoneal carcinomatosis is also frequently associated with gastrointestinal malignancies.
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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...
Review Article
Neoadjuvant Chemotherapy in the Management of Colorectal Metastases: A Review of the Literature
Colorectal cancer accounts for the most number of deaths after lung cancer, both in the West as well as locally in Singapore. Liver is the most common site of metastasis in colorectal cancer; an estimated 15% of patients will present synchronously, whilst approximately 50% will develop hepatic secondaries at...
Original Article
Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience
Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy in certain cases provide curative treatment, more than 50% will develop metastases in the course of their disease.
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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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Review Article
Current Concepts of Tumour Metastasis
Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor prognosis in patients with cancer. Early metastasis concepts were based upon the premise of uninterrupted tumour growth, stepwise spread of tumour cells with the inevitable...
Review Article
Chemoprevention of Colorectal Cancer – Experimental Approach and Clinical Applications
The age-old adage of “Prevention is Better than Cure” is still very relevant in today’s practice of medicine. Many randomised population trials have already shown that colorectal cancer mortality is reducible through early detection and screening.
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Review Article
Practical Issues in Adjuvant Therapy for Rectal Cancer
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Review Article
Total Mesorectal Excision (TME) – Twenty Years On
In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing optimal tumour clearance for patients with rectal cancer. Five cases were described where minute foci of adenocarcinoma was demonstrated in the mesorectum several centimetres distal...
Original Article
Flat and Depressed Lesions of the Colon and Rectum: Pathogenesis and Clinical Management
It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal cancers which developed from flat or depressed neoplastic lesions remained undetectable by conventional colonoscopy.
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Others
Surgical Management of Colorectal Metastases to the Liver
Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer.
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Editorial
Recent Advances in the Total Management of Colorectal Cancer
Considerable improvements in the survival and outcome of colorectal carcinoma have been made in recent years. These have been the result of advances in investigations, intervention as well as in follow-up management.
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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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Images in Medicine
An intensely pruritic disseminated skin eruption
A 64-year-old man presented to the dermatology outpatient clinic with a 4-month history of pruritic papules. He had a significant medical history of thyrotoxicosis, which was diagnosed 1 year prior and well controlled on carbimazole. He had no history of dyslipidaemia or underlying malignancy. The cutaneous eruption had first...
Review Article
Trauma-induced coagulopathy: Mechanisms and clinical management
Globally, trauma accounts for the highest number of mortalities in adolescents and young adults up to 49 years old.1 Of these deaths, a large percentage is attributable to exsanguination.2 Trauma-induced coagulopathy (TIC) occurs in 25–35% of hospitalised severe trauma patients and is associated with increased incidence of bleeding, blood...
Original Article
Novel transdermal device for delivery of triamcinolone for nail psoriasis treatment
Psoriasis is a chronic immune mediated inflammatory skin condition that affects about 2–4% of the Western populations, with rising incidence over the years.1,2 The presentation of psoriasis varies from mild localised plaques to more severe erythrodermic forms, with plaque-type psoriasis being the most common. It frequently affects the skin...
Editorial
Coagulopathy related to trauma: Is it time for a goal-directed approach?
Trauma represents a leading cause of death globally, and post-traumatic haemorrhage accounts for 40% of early mortality in spite of recent improvements in modern trauma care.1 Post-traumatic haemorrhage occurs primarily from direct injury to blood vessels, leading to exsanguination and hypovolaemic shock depending on the type and calibre of...
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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Review Article
Melanocytic Lesions of the Face: Diagnostic Pitfalls
Cutaneous melanocytic lesions are amongst the commonest tumours in all races but are more common in Caucasians with fair skin. Although most are benign melanocytic naevi that are readily diagnosed clinically, melanocytic lesions are commonly excised because of the concern that they may represent a melanoma or because of...
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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Review Article
A Review: The Location, Molecular Characterisation and Multipotency of Hair Follicle Epidermal Stem Cells
There have been significant advances in the understanding of keratinocyte stem cells since the 1970s, when the concept of interfollicular epidermis was initially proposed; later much work was focused on the specific region of the hair follicle outer root sheath, especially the bulge region (Fig. 1). Hair follicle stem...
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
Serum Interleukin-2, Interleukin-6, Tumour Necrosis Factor-Alpha and Nitric Oxide Levels in Patients With Behçet’s Disease
Behçet’s disease (BD) is characterised by oral aphthous lesions, genital ulcerations and eye inflammation. The disease was first described by Hulusi Behçet in 1937. Despite the diverse inflictions in different organ systems, vasculitis is perceived as the common basic pathological process in BD.
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Original Article
Clinico-pathological Analysis of Myelodysplastic Syndromes According to French-American-British Classification and International Prognostic Scoring System
Myelodysplastic syndromes (MDS) are a heterogeneous group of acquired clonal haemopoietic stem cell disorders characterised by ineffective haematopoiesis and peripheral cytopenia. The natural history ranges from the indolent forms spanning years to those with rapid evolution to blast transformation.
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Original Article
In vitro Biological Characteristics of Human Cord Blood-derived Megakaryocytes
Haematopoietic stem cell transplantation (HSCT) is now a well-established therapeutic modality for a broadening spectrum of medical problems. Umbilical cord blood (CB) has emerged as an alternative source of HSCT in recent years due to the lack of a human leukocyte antigen (HLA)-identical sibling donor in the majority of...
Review Article
Unrelated Umbilical Cord Blood Transplantation in Children and Adults
Allogeneic haematopoietic stem cell transplantation (HSCT) is an established form of treatment for many high-risk haematological malignancies and marrow failure syndromes. The use of HSCT is still limited by the availability of human leukocyte antigen (HLA) matched donors, even though unrelated donor registries have markedly improved the chances of...
Review Article
Haematopoietic Graft Engineering
Haematopoietic stem cell transplantation (HSCT) has become an established modality for the treatment of cancer and diseases of the bone marrow and immunological system. Such transplants effect their cures through 3 main avenues: namely, eradication of disease through intensive chemo/radiotherapy, replacement of defective blood-forming cells with normal haematopoietic progenitors...
Editorial
Stem Cells: Current Usage and Future Potentials
In recent years, the term “haematopoeitic stem cell transplantation” has replaced “bone marrow transplantation”. It is more precise and emphasises the “haematopoeitic stem cell” as the key element.
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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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Original Article
The HercepTest and Routine C-erbB2 Immunohistochemistry in Breast Cancer: Any Difference?
The proto-oncogene c-erbB2 (also known as HER2/neu) is located on chromosome 17q21 and encodes a 185-kD transmembrane glycoprotein. It belongs to the human epidermal growth factor receptor (tyrosine kinase receptor) family that plays an important role in the regulation of fundamental processes such as cell growth, survival and differentiation.
This...
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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Original Article
Cyclosporin in the Treatment of Severe Atopic Dermatitis: A Retrospective Study
Cyclosporin is a potent immunosuppressant that inhibits cell-mediated immunity, mainly via inhibition of T helper cells. It has been used successfully in the treatment of severe atopic dermatitis in children and adults, producing a rapid and highly significant improvement in terms of disease activity, pruritus and sleep disturbance.
This article...
Original Article
Salivary Immunoglobulin A and Lysozyme in Patients with Psoriasis
The pathophysiological mechanisms in psoriasis are still unclear. Many factors, such as infection, trauma and stress, could cause psoriasis.
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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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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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Others
Delusional Parasitosis: Case Series of 8 Patients and Review of the Literature
Delusional parasitosis (DP), or delusional infestation, is a condition in which a person has the unshakeable and mistaken belief of being infested with parasites. Originally described in 1894, it has been previously referred to as dermatophobia, parasitophobic neurodermatitis, parasitophobia or entomorphobia.
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Original Article
Laser Doppler Perfusion Imaging (LDPI) and Transepidermal Water Loss (TEWL) Values in Psoriatic Lesions Treated with Narrow Band UVB Phototherapy. Dermal Vascularity may be useful Indicator of Psoriatic Activity
Non-invasive techniques have become useful procedures in measuring skin physiology and skin response to treatment. This study attempts to objectively measure physiological changes in transepidermal water loss (TEWL), an indicator of skin barrier function, and laser Doppler perfusion imaging (LDPI), an indicator of dermal vascularity, of psoriatic skin lesions...
Original Article
Familial Risk of Allergic Rhinitis and Atopic Dermatitis among Chinese Families in Singapore
Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase in prevalence has also been attributed to the changes in lifestyle and urbanisation in developed countries.
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Original Article
Comparison of Completely versus Incompletely Excised Cutaneous Squamous Cell Carcinomas
Non-melanoma skin cancer is the most common skin cancer worldwide and its incidence has risen in the last few decades. Approximately 80% of non-melanoma skin cancers are basal cell carcinomas and the rest are squamous cell carcinomas (SCCs).
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Original Article
Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population
Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically diverse populations is important for the understanding of cancer patterns and also to provide clues for aetiologic studies.
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Original Article
Viral Warts in Children Seen at a Tertiary Referral Centre
Viral warts are a common affliction in children. It is caused by the human papilloma virus, of which there are more than 80 serotypes.
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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
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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Original Article
A Study on the Knowledge, Attitudes and Practices of Southeast Asian Dermatologists in the Management of Atopic Dermatitis
Atopic dermatitis (AD) is a chronic and pruritic inflammatory skin disorder that occurs worldwide. Several guidelines on the management of AD have been published in the literature.
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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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Original Article
Detection and Quantification of the Abelson Tyrosine Kinase Domains of the bcr-abl Gene Translocation in Chronic Myeloid Leukaemia Using Genomic Quantitative Real-time Polymerase Chain Reaction
Chronic myeloid leukaemia (CML) is a clonal stem cell malignancy characterised by massive proliferation of mature and immature granulocytes, basophils and spleen cells, but not cells of T cell lineage. The molecular hallmark of CML is the reciprocal translocation between chromosomes 9 and 22, t(9;22), which produces the Philadelphia...
Review Article
The Feminist Approach in the Decision-making Process for Treatment of Women With Breast Cancer
The ethical theories employed in healthcare today generally assume a modern Western philosophical framework, which is applied to many issues such as abortion, euthanasia, consent for treatment and organ transplantation. The application of this approach to non-Western cultures needs critical examination.
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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.
This article is available...
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
Diabetes as a Risk Factor for Periodontal Disease: Current Status and Future Considerations
Diabetes mellitus (DM) is a common and growing global health problem. It is highly prevalent in Asian communities. Hong Kong, Pakistan, and Singapore are among the countries with the highest prevalence of diabetes in the adult population.
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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.
This article is available only as a...
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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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...
Original Article
Phase II Trial of Gemcitabine and Cisplatin Sequentially Administered in Asian Patients With Unresectable or Metastatic Non-small Cell Lung Cancer
Lung cancer is the most common cause of cancer-related death worldwide. It ranks first among males and third among females in the incidence of cancers in Singapore.
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Original Article
Clinical Experience with Three Combination Regimens for the Treatment of High-risk Febrile Neutropenia
Cancer patients who become severely neutropenic as a result of intensive myelosuppressive chemotherapy are at high risk for developing life-threatening infections, and unless they are treated at the first sign of infection, the rate of mortality is high. Because of the defect in the inflammatory response, the classic signs...
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...
Original Article
Early Predictors of Mortality in Pneumococcal Bacteraemia
Streptococcus pneumoniae infection is the most common cause of community-acquired pneumonia worldwide.1 It has been associated with an approximately 10% rate of bacteraemia.2-4 Despite the advances in antibiotics, pneumococcal bacteraemia still carries a significant mortality rate.2-6
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Images in Medicine
Putting Together Lesions in the Brain, Retina, Kidney and Pancreas
A 40-year-old Malay lady presented with a 6-month history of headache. She had a past history of a left nephrectomy 6 years ago.
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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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Original Article
Electrocardiographic Changes in Patients with Cutaneous Leishmaniasis Treated with Systemic Glucantime
Antimonial compounds are regarded as the treatment of choice for cutaneous leishmaniasis (CL). The efficacy of sodium stibogluconate (pentostam) and the other compound of antimoniate meglumine antimoniate (glucantime) were reported in 1937 and 1946, respectively.
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Others
Methicillin-resistant Staphylococcus aureus Control in Singapore – Moving Forward
The significance of methicillin-resistant Staphylococcus aureus (MRSA) is indisputable. Its successful establishment and maintenance as the most important endemic healthcare associated infection (HCAI) results from its reservoir in up to 20% of inpatients and 16% of healthcare workers plus its ability to survive on surfaces for over 12 days.
This...
Letter to the Editor
Tuberculosis Masquerading as Recurrent Metastatic Carcinoma of the Cervix
The incidences of certain malignancies are increasing and are major causes of mortality. Diagnosis can be difficult and delayed.
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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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Review Article
Association of Epstein-Barr Virus with Nasopharyngeal Carcinoma and Current Status of Development of Cancer-derived Cell Lines
Although nasopharyngeal carcinoma (NPC) has been reported in almost all parts of the world, most cases of NPC are found in South East Asia, Southern China (including Hong Kong), North Africa and in the Eskimo population of Alaska, USA. For reasons that still remain unclear, the Chinese are more...
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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Letter to the Editor
Massive Retroperitoneal Adrenal Haemorrhage as the First Manifestation of a Lung Cancer
A 74-year-old man was admitted with sudden onset of right upper quadrant abdominal pain radiating towards right shoulder and right thigh. Pain was aggravated by deep breathing and movements.
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Others
4th FY Khoo Memorial Lecture 2008: Nasopharyngeal Cancer Workgroup – The Past, The Present and The Future
Thank you Madam Chairman. First, I would like to thank the Singapore Radiological Society and the College of Radiologists, Academy of Medicine Singapore for giving me the honor of delivering this the 4th FY Khoo Memorial Lecture, 2008.
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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...
Original Article
Phase II Trial of Gemcitabine in Combination with Cisplatin in Inoperable or Advanced Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) has a high incidence rate in Asia. In Singapore, it is the third most common cancer amongst males, and constituted 8% of all cancers diagnosed between 1998 and 2002.
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Letter to the Editor
Pancreas-only Metastasis from Nasopharyngeal Carcinoma
A 51-year-old Chinese man presented with a 3 month’s history of left cervical lymphadenopathy, rhinorrhoea, tinnitus and nasal congestion. On nasopharyngoscopy, a fungating mass was found in his nasopharynx and was biopsied.
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Letter to the Editor
Cutaneous Leishmaniasis Mimicking Squamous Cell Carcinoma
Leishmaniasis is a parasitic infection caused by different species of the obligate intracellular protozoa Leishmania. This disease is transmitted through the bite of an infected female sandfly.
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Original Article
Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience
Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year.
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Letter to the Editor
Successful Surgical Treatment of Renal Cell Carcinoma With Calvarial Metastases
Renal cell cancer (RCC) accounts for 3% of all cancers. Isolated haematuria or pain is the most common form of presentation.
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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...
Original Article
The Toxicity and Outcomes of Continuous 5-fluorouracil/Cisplatin-based Chemotherapy Followed by Chemoradiation in Patients with Resected High-risk Gastric Cancer: Results of a Single Institute
Gastric carcinoma is the second most common cause of cancer mortality worldwide. Surgery is the only curative therapy, although 5-year survival rates remain poor even after curative resection.
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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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Original Article
MMP-2, TIMP-2 and CD44v6 Expression in Non-small-cell Lung Carcinomas
Studies have provided data that matrix metalloproteinases (MMPs) facilitate tumour invasion, the establishment of metastases. On the other hand, matrix metalloproteinase inhibitors have been shown to inhibit tumour growth and dissemination in non-small-cell lung carcinomas (NSCLCs).
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Original Article
A Comparative Study of Polymerase Chain Reaction Detection of Clonal T-cell Receptor Gamma Chain Gene Rearrangements Using Polyacrylamide Gel Electrophoresis versus Fluorescence Capillary Electrophoresis
Cutaneous T-cell lymphomas (CTCL) are a heterogeneous group of malignancies of skin-homing T-cells, of which mycosis fungoides (MF) is the most common form. CTCL can be difficult to diagnose, especially in the early stages or in cases with atypical clinical presentation.
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Original Article
Use of Antibiotics in a Haematology Ward – An Audit
Rising rates of antibiotic resistance prompted a review of antibiotic use policies hospitalwide. The Department of Haematology established a new set of consensus guidelines in 2002 for antibiotic use in febrile neutropenia. We were tasked by the hospital’s Pharmacy and Therapeutics Committee to audit adherence to the guidelines.
This article...
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...
Original Article
Thirty-day Mortality and Morbidity After Total Knee Arthroplasty
Total knee arthroplasty (TKA) for patients with knee arthritis that is unresponsive to conservative treatment is being increasingly performed all over the world. It is a safe procedure with a low risk of perioperative death. Improvements in surgical techniques, as well as the identification and treatment of comorbidities, have...
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
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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...
Original Article
Predictors of Vancomycin-resistant Enterococcus (VRE) Carriage in the First Major VRE Outbreak in Singapore
Vancomycin-resistant enterococci (VRE) have emerged as one of the most challenging nosocomial threats in the past decade globally.1,2 Although antibiotic exposure may facilitate VRE transmission by providing selective advantage for VRE and increasing the concentration of VRE in the stools, antibiotic use in association with de novo development of...
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...
Original Article
Incidence of Cancer in Nodular Goitres
The incidence of malignancy in multinodular goitres have been found to vary from 4% to 17%.1 The incidence of malignancy in solitary nodules is not significantly higher.2 These studies alluded to the fact that the risk of malignancy in both multinodular goitres and solitary thyroid nodules is not negligible....
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.
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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
Mohs micrographic surgery in Singapore: A long-term follow-up review
Dear Editor,
Mohs micrographic surgery (MMS) has become the treatment of choice for high-risk non-melanoma skin cancers (NMSC) worldwide.1 Unlike wide local excision, MMS enables precise microscopic removal of tumour foci while allowing maximal tissue preservation, thereby maintaining cosmesis and anatomical function.1 The MMS service in Singapore started in...
Letter to the Editor
Lamotrigine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Singapore: A case series
Dear Editor,
With the advancements in pharmacogenetics, potential genetic associations with severe cutaneous adverse drug reactions (SCAR)—which include Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)—have been proposed. Lamotrigine is one of the 2 anticonvulsants found to be highly associated with SJS/TEN from the 2008 EuroSCAR study. Several...
Original Article
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore
As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be observed.1,2 This approach allows risk stratification that can reduce the rate of benign lesion removal by diagnostic lobectomies3 and its associated postoperative morbidity.4 However, thyroid...
Original Article
Characteristics of unplanned hospitalisations among cancer patients in Singapore
Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the rise and accounts for nearly 30% of total population mortality.4,5 Singapore data suggests that cancer patients accounted for 13% of total healthcare costs in 2016,...
Editorial
The case for better hospitalisation selection in cancer patients
Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been a significant strain on public healthcare systems to balance the demands of the pandemic and usual medical care.
There is little literature detailing emergency department (ED)...
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...
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
An Unusual Cause of Lymphadenopathy and Rash
A 38-year-old Chinese man who was previously well, presented with one month of fever and a non-pruritic rash involving the face, trunk and upper limbs. There was no oral, ocular or genital involvement. He denied weight loss, night sweats, fatigue or easy bruising and there was no history of...
Letter to the Editor
Cutaneous Angiosarcoma Associated with the Kasabach–Merritt Syndrome
Angiosarcoma is a rare tumour commonly affecting elderly men, usually occurring on the head and neck region. The tumour usually presents as ecchymosis-like plaques, and less commonly with haemorrhage, oedema, ulceration and recurrent facial angioedema.
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Original Article
Epidemiology of Skin Diseases in Renal Transplant Recipients in a Tertiary Hospital
Various types of skin lesions are more common in renal transplant recipients compared to the general population, mainly attributable to post-transplant immunosuppression. The well-documented drug-specific skin manifestations include cyclosporine-related hypertrichosis, gingival hypertrophy, steroid-induced acneiform eruption and striae.
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Original Article
Outcomes of Oral Tongue Cancer: Does Age Matter?
Oral cancer (including oral cavity and oropharynx) is the eighth most common cancer worldwide with oral cavity cancer among the 3 most common malignancies in south central Asia. Oral cavity cancer, including oral tongue, is associated with a relatively high mortality rate particularly in the developing countries.
This article is...
Letter to the Editor
Bosentan – A Previously Unrecognised Cause of Facial Telangiectasia
Bosentan is an endothelin-1 (ET-1) receptor antagonist approved for the treatment of pulmonary artery hypertension (PAH). Although flushing is a documented side effect of bosentan, the diagnosis can mimic other drug rashes and medical conditions where facial telangiectasis and/or flushing are prominent presentation.
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Letter to the Editor
Blistering Eruption Following a Rubefacient Rub for Shoulder Discomfort
A 96-year-old woman was referred as an emergency with a suspected allergic reaction to Deep Heat® rub (Mentholatum Company Ltd, East Kilbride, Scotland). Five days before referral, she developed pain and stiffness of her left neck and shoulder.
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Original Article
An 11-year Review of Dermatomyositis in Asian Patients
Dermatomyositis (DM) is an acquired multisystem inflammatory disease with prominent, characteristic cutaneous manifestations and proximal muscle myopathy. A clinically distinct amyopathic variant with typical skin signs but no muscle disease had been described as well.
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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...
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
Bone Marrow Cytogenetics Workup: Application of Lean Management System to Determine if Additional Cell Workup is Helpful and Necessary to Analysis
Cytogenetic studies are important to the diagnosis and monitoring of various haematopoietic disorders such as myelodysplastic syndrome (MDS), acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), lymphoproliferative disease (LPD), and multiple myeloma (MM). It can also provide a prognosis to a...
Images in Medicine
A Case of Congenital Haemolytic Anaemia and Thrombocytopenia
A 20-month-old boy came from Bangladesh to Singapore for medical consultation. He presented with progressive pallor, easy bruising, intermittent dark-coloured urine, and failure to thrive since birth.
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Images in Medicine
An Exanthem with An Annular Pattern in a 2-year-old Girl
A 2-year-old Chinese girl was seen in clinic with an erythematous annular itchy rash which began on the thighs and had spread to the trunk and hands. The parent’s concern was the rash’s duration and association with 2 episodes of fever.
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Letter to the Editor
Levofloxacin-induced Toxic Epidermal Necrolysis Treated with Intravenous Immunoglobulin
Toxic Epidermal Necrolysis (TEN) is a rare, fulminating rash with a mortality rate of 35%.1 It is predominantly medication-induced; allopurinol, ampicillins, anticonvulsants and non-steroidal anti-inflammatory drugs are commonly implicated.
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Original Article
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...
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.
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Editorial
Personalised Medicine for Psoriasis: A Real Possibility Ahead
In the last decade, our understanding of psoriasis has increased by leaps and bounds, resulting in many new targeted therapies being introduced for those with recalcitrant psoriasis. However, despite the plethora of new treatment options and biologics to treat the most difficult cases of psoriasis, dermatologists are still confronted...
Letter to the Editor
Coexistence of Unicentric Castleman’s Disease and Locally Advanced Papillary Renal Cell Carcinoma: More Than a Coincidental Association?
Castleman’s disease (CD) is an enigmatic lymphoproliferative disorder due to its rarity, uncertain aetiopathogenesis and heterogeneous clinicopathologic forms. This case report presents an unusual case of concomitant hyaline-vascular type CD of unicentric retroperitoneal localisation and stage IV (T2N2M0) papillary renal cell carcinoma (RCC).
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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
Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer
Pancreatic cancer is the fourth leading cause of cancer related mortality worldwide with an estimated 34,290 deaths recorded in the United States in 2008. Of these, pancreatic ductal adenocarcinoma (PDAC) accounts for ~90% of all cases.
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Images in Medicine
Erythematous Plaques in a Filipino Man
Three years after emigrating from Philippines to Singapore, a 34-year-old, otherwise healthy man presented with a progressive erythematous eruption on his lower limbs. Six months prior to presentation he noticed a few rythematous plaques on his right lower limb, which were gradually increasing in size and later spread to...
Original Article
Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore
Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A study analysing pooled FN data from 115 US academic medical centres between 1995 and 2000 showed that the overall in-hospital mortality was 9.5%, whereas pooled...
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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Original Article
An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution
Thyroid lesions constitute a considerable bulk of surgical practice, majority of which are thyroid nodules. A large population study revealed that clinically apparent thyroid nodules were present in 6.4% of women and 1.5% of men.
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Original Article
Intramuscular Gentamicin Improves the Efficacy of Ciprofloxacin as an Antibiotic Prophylaxis for Transrectal Prostate Biopsy
Transrectal ultrasound guided prostate biopsy (TRPB) is one of the modalities in the diagnosis of prostate cancer. Its use has increased with the widespread use of serum prostate-specific antigen (PSA). It is generally a safe procedure with acceptable complication rates.1 However, when infective complications occur, it is potentially fatal.2...
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...