Dear Editor,Breast-conserving surgery (BCS) followed by radiation therapy for breast cancer offers improved cosmetic results and comparable long-term survival rates as mastectomy.1 However,...

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...

Dear Editor,The Academy of Medicine, Singapore (AMS) guideline on the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy in the hospital setting and an...

Dear Editor,I refer to the editorial “Ensuring safe sedation during gastroendoscopy”1 and the original article “Academy of Medicine, Singapore clinical guideline on the use...

Dear Editor,Propofol is a potent intravenous sedative-hypnotic agent. Its popularity for sedation has increased in the last 3 decades because of its smooth, rapid...

Dear Editor,We read with interest the paper by Ang et al.1 on Singapore guidelines in the use of sedation by non-anaesthesiologists during gastrointestinal endoscopy...

Dear Editor,Symptomatic haemorrhoids is the most common anorectal disorder, where up to 75% of people experience symptoms sometime in their lives.1The current gold standard...

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...

The prevalence of human immunodeficiency virus (HIV) infection is rising at an exponential rate in Singapore. The surgical experience with this disease remains limited.This...

Radiation bowel injury is a significant clinical problem because of the technical difficulties of surgery. Among the more common causes is radiation of carcinoma...

Economic and social pressures are compelling surgeons to modify their practice. An increasing number of procedures are being done in an outpatient setting.This article...

Cardiopulmonary resuscitation (CPR) is widely practised for cardiopulmonary arrests with variable success. The initial intention was to defibrillate patients with ventricular fibrillation after acute...

First described by Johannes Muller in 1838 as a large, benign tumour of the breast. Phyllodes tumour is a rare pathological entity, accounting for...

Thyroid nodule is a common problem in surgical practice. In 1994, more than 350 thyroid operations were performed in our department, of which 183...

Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented...

Mr Koh Yong Guan, guest-of-honour; Dr Tan Ser Kiat, Master, Academy of Medicine; Dr K C Tan, Chairman, Chapter of Surgeons; Dr Robert Jalleh...

Doran, in 1903, reported the first case of adrenal cyst described by Greiselius in 1670. It was not until 1966 that Foster reported the...

Thoracoscopy was first introduced by Jacobaeus nearly a century ago. With the development of endoscopic equipment and the recent surge of interest in minimally...

The multiply injured patient presents a challenge to even the most experienced surgeon. These patients often present in shock and require a rapid diagnostic...

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

Alternative medicine has become widely publicised throughout the world. Alternative medicine practitioners (AMPS), which include Oriental medicine doctors, traditional Chinese medicine practitioners, naturopaths and...

Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of...

Although debridement of portions of liver that prolapsed through war wounds was recorded from distant times, attempts at resection of a solid liver tumour...

Colour image analysers have been extensively used in medical research since 1970 for histomorphometric studies. Image analysis gives more information and a better understanding...

Despite intensive research and intervention, trauma continues to be the leading cause of death during the first three decades of life in the USA,...

Liver transplantation (LTx) is the treatment of choice for many patients with end stage liver disease. However liver allograft availability prevents its widespread application.This...

Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years,...

Inguinal hernia is one of the commonest surgical pathologies in the world. Laparoscopic totally extraperitoneal repair has been gaining popularity in recent years.This article...

There has been a rapid increase in clinical trial activity in Singapore and other parts of Asia. Randomised clinical trials are the “gold standard”...

Beginning in 1991, the Department of Forensic Medicine (DFM), which undertakes all Coroner’s casework locally, embarked on an on-going review of Coroner’s perioperative autopsies...

Western literature reports a very high incidence of deep vein thrombosis in its population especially after orthopaedic surgery. In total knee replacement without prophylaxis,...

Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of...

In the last century, Sir William Ferguson said: “amputation—one of the meanest and yet one of the greatest operations in surgery: mean, where resorted...

Although there has been a significant decline in elective surgery for peptic ulcer disease with the introduction of H-2 blocker, the incidence of peptic...

Firstly may I thank the Academy of Medicine and the Chapter of Surgeons for giving me this great privilege and honour to deliver the...

Although the incidence of oesophageal carcinoma is declining, it still remains a common cancer in Singapore. From 1988 to 1992, it was the ninth...

Thyroglossal duct remnant is one of the most common lesions of the anterior midline neck. It occurs in 7% of adults1 and carcinoma is...

On a global basis, the use of ultrasonography to assist clinicians in obtaining timely diagnoses in abdominal trauma is not particularly new. The first...

Acute appendicitis is a common surgical emergency. However, it is often difficult to make an accurate preoperative diagnosis, especially during the early stage of...

The National University of Singapore was started in 1905. Since then, it has trained many generations of medical practitioners.This article is available only as...

Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that...

Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While...

Mucinous cystadenoma of the vermiform appendix is an uncommon entity. It is a benign lesion but may disseminate and lead to the development of...

Melanocytic naevi are benign proliferation of melanocytes of congenital and acquired types which usually appear during adolescence or early adult life. Naevi are of...

Over the past decade, sonography as a screening tool in the evaluation of abdominal trauma has been thoroughly investigated. This modality was first used...

Surgeons as well as patients have recently shown much interest in stapled haemorrhoidectomy. This is a new technique, which is claimed to result in...

The recorded history of breast cancer management spans four millennia. This story about breast cancer management is also one about change, about resistance to...

Internal hernia is defined as the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. This...

Advances in diagnosis and therapy in the second half of the 20th century have lead to impressive improvements in survival for patients with many...

Today, laparoscopic surgery has achieved widespread acceptance among surgeons as well as the general public. Emergency laparoscopic procedures (ELPs) have been performed since the...

The carotid body was first described by von Haller in 1743. It is often a small ovoid or irregular mass composed of compact pinkish...

Intrahepatic biliary stone or hepatolithiasis is an uncommon entity worldwide, with a higher incidence in East Asia in comparison to the West. As yet,...

Acute ischaemia of the bowel is a devastating condition. Recently published figures on mortality range from 30% to 60%.This article is available only as...

The perioperative management of surgery for laparoscopic resection of phaeochromocytoma presents a significant challenge. Many different anaesthetic techniques and drugs have been used to...

Health-related quality of life (HRQoL) refers to patients’ perceptions of their own functioning and well-being. HRQoL is increasingly being used as a primary or...

Infertility is defined as the inability to conceive after 1 to 2 years of unprotected intercourse. In general, an estimated 84% of all women...

The Severe Acute Respiratory Syndrome (SARS) has been identified as a new clinical entity in the year 2003. It was on 12 March 2003...

Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy...

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

In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing...

It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal...

Anorexia nervosa, bulimia and binge-eating disorder are the three best described ‘eating disorders’. All three are predominantly disorders of women with the core symptoms...

The World Health Organization defines suicide as an act with a fatal outcome that is deliberately initiated and performed by the person himself or...

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...

Next year, we celebrate a hundred years of medical education in Singapore. We have come a long way since 1821 – from a small,...

The littoral cells line the vascular channels of the red pulp of the spleen and have characteristics of endothelial and histiocytic cells. In 1991,...

The only published study on Behcet’s disease in Singapore by Tan E et al (34 patients at the National Skin Centre) found that only...

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is...

Minimally invasive donor nephrectomy using laparoscopic techniques has become a very attractive method of procuring kidneys from live donors, compared to the traditional standard...

Family history has been shown to be a risk factor for the development of allergic rhinitis (AR) and atopic dermatitis (AD). However, the increase...

Dengue fever/dengue haemorrhagic fever (DF/DHF) is a re-emerging disease that is endemic in the tropical world. It is caused by 4 closely-related dengue viruses...

The advent of laparoendoscopic surgery in children has opened new avenues of treatment with added benefits but at the same time demands adequate training...

Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with...

The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely...

Buprenorphine, more commonly known as Subutex (Reckitt Benckiser Pharmaceuticals), has been released in Singapore since 2002. Initially marketed as an opiate substitute to help...

Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via...

Sleep physicians have only recently began to learn much about the epidemiology of sleep-disordered breathing (SDB) from large, well conducted prospective community-based studies. These...

In clinically-oriented subjects such as surgery, specific guidelines for conducting small group teachings are lacking. Different methods are being practiced and researched in different...

A 37-year-old man with no significant medical history underwent dental treatment. An injection dental needle used in the course of root canal treatment came...

This is a proud year for the medical profession in Singapore, as we celebrate 100 years of medical education. As the oldest faculty in...

For a very long time, King Edward VII (endearingly abbreviated “KE”) was synonymous with the medical school and its associated hall of residence. The...

A record of Diagnostic Radiology would be incomplete without reference to Wilheim Roentgen, who discovered the rays that he could not comprehend; hence, X-rays....

Fungaemia carries with it high mortality rates and appropriate as well as timely antifungal therapy has been shown to be life saving. Amphotericin B...

In this issue, the articles (historical, original and review papers) highlight the extent and problem of antimicrobial resistance in Singapore. The authors should be...

Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate...

Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998, and 2.4% in countries with market and former...

Diabetic retinopathy (DR) is a leading cause of vision loss in Asia. Singapore has one of the highest prevalence rates of diabetes mellitus (DM)...

Mahathir Mohamad was born in 1925 in Alor Setar, Kedah. In 1947, after living through the turbulent times of the Second World War, he...

Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases...

The Singapore healthcare philosophy aims to establish a healthy population through preventive healthcare programmes and public health education. Public education usually emphasises the adverse...

Great strides in laparoscopic surgical techniques have been progressively made throughout the various surgical subspecialties. More procedures can be performed laparoscopically today than when...

Burkitt’s lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin’s lymphomas. It is predominantly seen in children but may also...

Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain...

The danger posed by emerging infectious diseases has become greater in the past few years with the World Health Organization (WHO) warning that the...

Benzodiazepines (BDZs) (commonly known as “sleeping pills”) are routinely and successfully used in the treatment of sleep and anxiety disorders. However, studies have indicated...

A history of the Chapter of Pathologists would be incomplete without a history of the specialty of Pathology in Singapore. Pathology is in fact...

The transformation of the previous Chapter of Physicians, Academy of Medicine, Singapore to the current College of Physicians, Singapore in 2004 was the outcome...

The arrival of Sir Stamford Raffles in 1819 herald the birth of western medicine in Singapore. Doctors were then sent here from Britain. These...

The Academy of Medicine was founded in 1957 as the professional corporate body of medical and dental specialists in Singapore. From a modest beginning...

Medulloblastoma (MBL) is the most common type of malignant brain tumour in childhood. It belongs to the group of tumours known as primitive neuroectodermal...

Intravenous thrombolysis in acute cerebral infarction has been proven to be efficacious in improving functional outcome if given within 3 hours from stroke onset.1...

Pathological gambling has been defined as a persistent and recurrent maladaptive gambling behaviour that disrupts personal, family and work life. The diagnosis is not...

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...

Basic military training (BMT) is seen as a vital initiation phase into military service when new recruits are conditioned to the rigours of military...

The subject of place of death was brought to the forefront of the medical community in July 2004 when 2 important publications were released;...

Singapore is a city-state in Southeast Asia, with a total population in 2007 of 4,839,400, of which 3,642,700 (75.3%) are Singaporean residents. The remaining...

Endometrial cancer is the third most frequent gynaecologic cancer in Korea, following cervical cancer and ovarian cancer. With the increasingly Westernised lifestyles of Korean...

With the increasing availability of ultrasound and computed tomography scans, more patients are being diagnosed with incidental renal tumours. Up to 80% of tumours...

Information and communication technologies, such as internet portal and short message system (SMS), are increasingly used in healthcare delivery worldwide.1,2 Typically, these technologies are...

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

Colorectal cancer (CRC) is one of the commonest cancers worldwide with age standardised incidence rates of 22.8 to 64.2 and 19.0 to 46.7 per...

The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent...

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom...

Desmoid tumours are fibrous benign tumours that are often indolent until local symptoms evolve. We highlight a rare case of a ruptured intra-abdominal desmoid...

Obesity is one of the most common chronic illnesses in the Western World with a frequency of 10% to 15%. It causes or exacerbates...

Obesity or excess body fat is strongly associated with enhanced risks of morbidity and mortality, and its prevalence is rapidly escalating worldwide. Despite these...

Since its introduction a few decades ago, endoscopic retrograde cholangiopancreatography (ERCP) has brought about a significant change in the management of choledocholithiasis. With continual...

Type 2 diabetes mellitus is a major chronic disease globally. With increasing life expectancy, long-term complications of diabetes mellitus leading to significant morbidity and...

Pathological gambling is categorized under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) as an impulse control disorder not elsewhere classified....

The advent of the highly active antiretroviral therapy (HAART) era has greatly reduced the mortality and incidence of new diagnoses of acquired immune deficiency...

Since the first case of human immunodeficiency virus (HIV) was diagnosed in Singapore in May 1985, a total of 4845 cases and 1389 HIV/acquired...

Cutaneous melanoma is the most common cause of mortality amongst skin cancer in Caucasian populations and incidence rates per 100,000 patient years vary between...

Breast cancer is the leading cancer among women in Singapore, accounting for 29% of all cancers occurring in women between 2006 and 2010. Evidence...

Hoarding is defined as the acquisition of, and inability to discard items even though they appear to others to have no value, leading to...

Acute appendicitis is one of the most common causes of acute abdominal pain requiring surgical intervention. The traditional operation of choice was the open...

A 45-year-old Chinese woman with no medical history or regular medications presented with painful nodules on her left shin that progressed to involve her...

Osteogenic sarcoma (OS) is a primary malignant tumour of the bone, derived from primitive bone-forming mesenchyme and characterised by the production of osteoid tissue...

A 61-year-old Chinese woman presented to the general surgery clinic for a long-standing lump over her proximal medial right thigh. The painless lump was...

Marjolin’s ulcers are malignancies that arise from areas of chronic irritation or injury that undergo malignant transformation after a period of many years. Such...

The first reported case of liver biopsy was recorded in 1883 by Ehrlich. Since then, the technique of liver biopsy has been modified tremendously...

Dear Editor,Low-grade fibromyxoid sarcoma (LGFMS) is a rare form of neoplasm that usually occurs in the deep soft tissue of the lower limbs with...

Similar to other developed countries in Asia, including Japan, South Korea and Taiwan, the population of Singapore is ageing rapidly. In 2011, 9.3% of...

Singapore is experiencing an unprecedented age shift as the post-war baby boomers turn 65 years in 2012. Currently there are 378,700 people aged 65...

Work-related low back disorders consist of both low back pain (LBP) and low back injuries. They are a significant and increasing problem all over...

In 2010, Duke-NUS Graduate Medical School (Duke-NUS) and Singapore Healthcare Services (SingHealth) launched an initiative to improve the lives of patients by combining their...

A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC...

The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As...

Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown....

Oesophageal cancer is the 7th most common cancer in the world, with 572,034 new cases diagnosed in 2018, and is the 6th most common...

Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB)...

In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which...

EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on...

Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was...

Singapore confirmed its first case of COVID-19 on 23 January 2020 in a Chinese national from Wuhan, and its first paediatric case on February...

Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted...

Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates...