Letter to the Editor
A perfect match: The story of robotics in gynaecology
Dear Editor,
The first use of surgical robotics started in the domain of orthopaedic and urological surgery. However, it was the initial concept of using a robot in performing remote damage control surgeries on the battlefield that sparked the commercialisation of robotic surgical technology for use in operating rooms.1 The...
Images in Medicine
Cause of vaginal spotting in an older woman
A 77-year-old Chinese woman with a past medical history of Sjogren’s syndrome, nodular goitre and right-sided neck lymphadenopathy, presented to the gynaecological service for per-vaginal spotting. On clinical examination, she was noted to have a cervical polyp. A polypectomy was performed and the specimen was sent for histological examination.
The...
Commentary
Congenital cytomegalovirus infection: Advocating for screening and education
Cytomegalovirus (CMV) infection is the leading non-genetic cause of congenital neurosensory hearing loss in children, accounting for 21% of cases of hearing loss at birth and 25% of deafness at age 4 years.1 It can also give rise to other serious sequelae such as cerebral palsy, cognitive impairment, seizures...
Letter to the Editor
Retrospective analysis of neonates born after assisted reproductive technology and admitted to the neonatal intensive care unit
Dear Editor,
There are limited studies evaluating neonatal outcomes after assisted reproductive technology (ART) in Asia, especially Southeast Asia, hence this study aimed to fill this gap in literature. We conducted a retrospective study on a group of neonates conceived via ART performed at the National University Hospital (NUH),...
Original Article
Diagnosis and management of polycystic ovary syndrome: Perspectives of clinicians in Singapore
Polycystic ovary syndrome (PCOS) is a common endocrine disorder estimated to affect 4–21% of women, depending on the diagnostic criteria used.1 Clinical manifestations of the syndrome are varied, and multiple parameters are needed for its diagnosis.2,3 This complicates the diagnosis of PCOS and may cause patient dissatisfaction arising from delayed...
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.
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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.
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Others
Repair of Complex Ureterovaginal and Vesicovaginal Fistulas with Ileal Cystoplasty and Ureteric Reimplantation into an Antireflux Ileal Nipple Valve—A Case Report
Urogenital fistulas are a known but uncommon complication of gynaecological surgery, especially those involving a malignant process. Its incidence does not exceed 2%.
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Others
A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer
To our knowledge this is the first reported case of an isolated vesicocutaneous fistula related to previous radiation therapy for recurrent vulvar cancer.
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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.
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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.
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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.
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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...
Original Article
Urinary Deoxypyridinoline is a Useful Biochemical Bone Marker for the Management of Postmenopausal Osteoporosis
Postmenopausal osteoporosis is the most common cause of osteoporosis. It is heralded by the cessation of oestrogen production by the ovaries resulting in at least 10% to 15% bone loss over the next 10 to 15 years from menopause.
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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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Original Article
Rapid One-day Fluorescence In Situ Hybridisation in Prenatal Diagnosis Using Uncultured Amniocytes and Chorionic Villi
The most common chromosomal abnormalities in newborns are trisomy 21, trisomy 18, trisomy 13, and monosomy X, with incidences of 1/800, 1/8,000, 1/20,000, and 1/10,000, respectively. Conventional cytogenetic approaches traditionally employ foetal cells from amniotic fluid (AF) or chorionic villus (CV) grown in vitro and metaphase banding for chromosome...
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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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.
This article is...
Original Article
Factors Affecting Success in an Embryo Cryopreservation Programme
The first pregnancy resulting from the thaw and transfer of cryopreserved pre-embryos was reported in 1983 by Trounson and his team, in Melbourne, Australia. This technological breakthrough in infertility treatment has been successfully repeated since then and cryopreservation of excess embryos now forms an integral part of any assisted...
Original Article
Hyperlipidaemia during Normal Pregnancy, Parturition and Lactation
Increase in the plasma lipid fractions in normal pregnancy have been described but irregularity of sampling, difference in materials studied (whole blood, serum, and plasma) and the variations in the method of reporting precluded any comparison of results. In Western populations normal pregnancy leads to an increase in cholesterol...
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
Genetics of Male Infertility: Role of Androgen Receptor Mutations and Y-Microdeletions
Three to four per cent of men have severe defects in sperm production that result in infertility. Most of these men are healthy and the causes of depressed spermatogenesis are rarely identified with certainty.
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Others
Association or Agreement
Association and agreement between two factors are very different concepts, although the methods used to describe them appear similar. For example, the association between levels of aflatoxin serum albumin adducts and dietary aflatoxin intake can be demonstrated in a bivariate scattergram; the agreement between two methods of measuring aflatoxin...
Original Article
Microdochectomy for Single-duct Nipple Discharge
Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of all breast symptoms.
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Original Article
Prevention of Human Immunodeficiency Virus (HIV) Transmission from Mother to Child—A Cohort Study in Singapore
Since the onset of the acquired immunodeficiency syndrome (AIDS) epidemic in the mid-1980s, the number of HIV-infected cases has risen sharply throughout the world. Globally, 5.8 million new HIV infections have been diagnosed in 1998 with 1.2 million being diagnosed in Southeast Asia.
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Others
Book Review
The above is a textbook of medicine written by Singapore doctors and published in Singapore. It is difficult not to be over-enthusiastic about it as there are so few books of medicine written and published in Singapore.
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Original Article
Obstetric Admissions to the Intensive Therapy Unit of a Tertiary Care Institution
Pregnancy is associated with physiological changes in various organ systems and complications arising from the interaction between these changes and disease processes may be severe enough to require admission to the intensive therapy unit (ITU) for management. The purpose of this study was to review all obstetric patients admitted...
Others
Management of Premalignant Lesions of the Cervix
Cervical cancer is one of the most common female cancers worldwide. It is ranked second only to breast cancer and in many underdeveloped countries, it is the most common female cancer.
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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
Rheumatic Heart Diseases in Pregnancy
Rheumatic heart disease comprises acute rheumatic fever following group A beta-haemolytic streptococcal infection of the tonsillopharynx, and its long-term sequelae of heart valve fibrosis causing chronic valvular lesions. Severe myocardial and pericardial involvements are much less common.
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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
Current Understanding of Pre-eclampsia
Pre-eclampsia is a major cause of adverse obstetric outcome. It remains one of the leading causes of maternal mortality1 and continues to contribute significantly to perinatal morbidity and mortality.
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Review Article
Management of Thromboembolic Disease in Pregnancy
Venous thromboembolism (VTE) refers specifically to 2 related entities: deep vein thrombosis (DVT) and pulmonary embolism. The management of arterial thrombo-embolism, in particular that of women with artificial heart valves, is beyond the scope of this paper.
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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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Review Article
Thyroid Diseases in Pregnancy
Abnormalities of thyroid function associated with pregnancy encompass both hyperthyroidism and hypothyroidism. These may have been present before the onset of pregnancy, or occurred only during or after pregnancy.
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Original Article
Outcome of Pregnancy in Asian Women with Systemic Lupus Erythematosus: Experience of a Single Perinatal Centre in Singapore
Systemic lupus erythematosus (SLE) is a chronic systemic connective tissue disease with a reported prevalence of 5 to 100/100,000. Women are affected much more commonly than men (ratio 9:1), particularly those in the child-bearing age (15:1).
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Original Article
Pregnancy after Renal Transplantation: Experience in Singapore General Hospital
Successful renal transplantation significantly improves the sexual and reproductive functions of women with end-stage renal disease and offers the best hope for those who wish to have children. Conception rate has been reported to improve dramatically from 1 in 200 dialysis patients to 1 in 50 women with a...
Original Article
Gestational Diabetes Mellitus: A Call for Systematic Tracing
The prevalence of diabetes is increasing worldwide. In Singapore, the prevalence of diabetes has increased dramatically from 4.7% in 1984 to 8.6% in 1998. Diabetic complications lead to a significant number of patients with blindness, amputations and end-stage renal failure annually.
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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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Original Article
Are Maternal Deaths on the Ascent in Singapore? A Review of Maternal Mortality as Reflected by Coronial Casework from 1990 to 1999
It is said that, worldwide, over half a million maternal deaths occur annually. This might well be a conservative estimate, given the difficulties inherent in collecting the relevant data, compounded by the under-reporting and misclassification of such deaths.
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Editorial
Medical Disorders in Pregnancy—The Challenges Ahead
Nowhere is the fate of two individuals more closely intertwined than that of the mother and her fetus. Pregnancy is a unique state where the physiology of the mother is greatly altered to accommodate the newly developing “organ”—the fetus.
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Review Article
Osteoporosis in Relation to Menopause
Singapore has a rapidly ageing population. In 1990, only 6% of the population was above the age of 65 years but this percentage of elderly citizens will rise rapidly to 17% by the year 2030. As Singaporean women achieve longer life expectancy and live a greater portion of their...
Original Article
Burch Colposuspension: Review of Perioperative Complications at a Women’s and Children’s Hospital in Singapore
Genuine stress incontinence (GSI) is the most common cause of female urinary incontinence. When conservative treatment fails, surgery is indicated. Open Burch colposuspension is an established surgical procedure1 and remains the gold standard upon which the efficacy of newer surgical options is evaluated.
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Others
Endometrioid Adenocarcinoma of the Uterus: Surgico-Pathological Correlations and Role of Pelvic Lymphadenectomy
Endometrial cancer is the most common female genital malignancy in industralised countries today. Despite the overall favourable prognosis in this neoplasia, survival is associated with several prognostic factors. In endometrial cancer, one of the most potent prognostic factors is nodal metastasis.
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Others
FIGO Stage 1B2 Cervical Carcinoma – The KK Women’s and Children’s Hospital Experience
Important prognostic factors in stage 1B cervical carcinoma include primary tumour diameter, nodal metastases, depth of stromal invasion, lymph-vascular invasion, microscopic parametrial extension and status of surgical margins.1 In 1994 FIGO addressed the significance of tumour diameter by designating stage 1B into 1B1 (clinical lesions no greater than 4.0...
Others
Bowel Surgery for Epithelial Ovarian Cancer – An Early Case Series
Epithelial ovarian cancer is the leading cause of death in patients with gynaecological malignancies in Singapore and developed countries, the main reason being the advanced stages of the disease (stage III or IV) at diagnosis. This is largely due to the lack of an effective screening tool to detect...
Others
Pregnancy Following Embolisation of Uterine Arteriovenous Malformation – A Case Report
Arteriovenous malformations (AVMs) of the uterus are rare but potentially life-threatening lesions. The common presentation is vaginal bleeding and, if not diagnosed correctly, can result in torrential bleeding, especially following dilatation and curettage.
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Others
A Case Series of Gastrointestinal Abnormalities in Fetuses with Echogenic Bowel Detected During the Antenatal Period
Although the presence of fetal echogenic bowel (EB) has been largely regarded as benign, it has been viewed as a soft marker for various congenital anomalies. To date, no studies have been conclusive and the importance of antenatal EB amongst the low-risk population has remained confusing.
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Others
Audit of ‘Crash’ Emergency Caesarean Sections Due to Cord Prolapse in Terms of Response Time and Perinatal Outcome
Umbilical cord prolapse is an uncommon intrapartum event with a reported incidence of 1 in 160 to 714 deliveries. Predisposing factors include fetal malpresentation, prematurity, small fetal size, multiple gestation, polyhydramnios and membranes rupture prior to head engagement.
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Others
Quality Control Assurance in National Screening Programmes for Cervical Cancer
The National Health Service (NHS) was established in the United Kingdom (UK) in 1948, against a post-war background of poverty and ill health. The aim was to provide healthcare based on need to all citizens of the UK, free at the point of delivery.
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Others
The Combined Oral Contraceptive Pill in Women Over Age Forty
In the 1970s, several studies appeared to suggest that users of oral contraceptives (OCs) were at increased risk of cardiovascular events. More recently following newer studies on lower dose OCs and re-analysis of the old studies, it was concluded that the risk of cardiovascular accidents was attributable primarily to...
Others
Contemporary Management of Fibroids
Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in most women.
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Others
Investigating the Infertile Couple
Infertility is defined as the inability to conceive after 1 to 2 years of unprotected intercourse. In general, an estimated 84% of all women would conceive after a year of intercourse.
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Others
Use of Hormone Replacement Therapy in the Asymptomatic Postmenopausal Woman: What is the Current Evidence?
The understanding of hormone replacement therapy (HRT) for postmenopausal women has undergone dramatic change since the publication of the results of the Women’s Health Initiative (WHI) study in July 2002.
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Others
Fetal Cells in Maternal Blood: State of the Art for Non-Invasive Prenatal Diagnosis
Without prenatal diagnosis, 1 in 50 babies are born with serious physical or mental handicap, and as many as 1 in 30 with some form of congenital malformation. These may be due to structural or chromosomal abnormalities, or single gene disorders.
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Others
Human Papillomavirus Triage of Patients with Atypical Squamous Cells of Undetermined Significance on Cervical Papanicolaou Smear
Cervical cancer affects >400,000 women a year worldwide, and represents a significant health issue for women. In the United States (US) however, screening programmes have reduced the incidence to 8.3 cases per 100,000 women with only 14,000 cases and 5000 deaths annually.
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Others
Screening for Chromosomal Anomalies: First or Second Trimester, Biochemical or Ultrasound?
A chromosome abnormality contributes significantly to fetal loss during pregnancy, and perinatal morbidity and mortality. The contribution of chromosomal abnormalities to fetal loss decreases as pregnancy progresses; an estimated 50% of first-trimester spontaneous abortions are due to chromosomal abnormalities.
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Others
Should Doctors Perform an Elective Caesarean Section on Request?
Caesarean sections performed without medical indication, better known as maternal request caesarean sections, have generated intense debate in recent times. While uncommon in the past, a recent national audit in the United Kingdom (UK)1 revealed that 7% of all elective caesarean sections were performed for precisely this reason.
This article...
Editorial
Recent Advances in Obstetrics and Gynaecology
The science and art of providing quality health care to women has made tremendous strides in recent years. In the subspecialties of Obstetrics and Gynaecology, recent advances in laboratory techniques and in clinical diagnostic, surgical and laparoscopic skills have improved the prevention and early detection of disease.
This article is...
Review Article
MR Imaging of the Fetal Brain and Spine: A Maturing Technology
The introduction of a new diagnostic test into a clinical arena goes through a number of stages. The first stage is technical development.
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Others
The Use and Abuse of Steroids in Perinatal Medicine
Preterm birth, delivery prior to 37 weeks of gestational age, accounts for a major and disproportionate amount of infant and neonatal morbidity and mortality. Despite advances in medical technology, the prevalence of preterm birth in Singapore has increased, secondary to an increase in multiple gestations and obstetric interventions.
This article...
Original Article
Changing Trends in Indications for Caesarean Sections in a Tertiary Hospital
Increasing rates of caesarean deliveries have received widespread attention in recent years and has increased widespread discussion in the public domain. The ideal caesarean section rate has never been defined and national rates of caesarean delivery vary from country to country.
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Review Article
Obstetric Cholestasis: Current Opinions and Management
Obstetric cholestasis (OC) is a pregnancy-specific liver disorder. It is also known by other names, such as pruritus gravidarum, recurrent intrahepatic cholestasis of pregnancy and obstetric hepatosis.
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Review Article
Advances in Imaging in Prenatal Diagnosis and Fetal Therapy
Technology in sonography has advanced tremendously in recent years, contributing to improvements in clinical applications for prenatal diagnosis and fetal therapy. These include transvaginal scanning, harmonic imaging, Doppler imaging, 3-dimensional (3D) ultrasonography and magnetic resonance imaging (MRI) ultrafast sequences.
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Review Article
Factors Influencing Fetal Growth
Birth weight remains one of the most important measures we have of the health status of a population, being a strong predictor of both mortality and morbidity, and reflecting nutritional status and growth rates. Yet, the estimation of the normal growth potential — and hence the definition of growth...
Original Article
Improving the Uptake of Human Immunodeficiency Virus (HIV) Antenatal Screening in a Primary Healthcare Setting
Since the acquired immunodeficiency syndrome (AIDS) was first diagnosed in Singapore in 1985, its incidence rose from 15 cases in 1988 to 226 in 2000. There has also been a change in the profile of AIDS patients over this period.
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Letter to the Editor
Labour epidural practice in a tertiary training centre
Dear Editor,
Labour analgesia provided through the central neuraxial approach is offered for parturients who are in their active stage of labour, usually after 2–4cm of cervical dilatation. Lumbar epidural, the gold standard for labour analgesia, is recently recommended over other alternative methods of analgesia such as pressurised gaseous nitrous...
Original Article
Evaluation of a Bedside Test for Phosphorylated Insulin-like Growth Factor Binding Protein-1 in Preterm Labour
The diagnosis of preterm labour poses a problem. Preterm labour accounts for about 50% of preterm births; however, most data reveal that only about 20% of women presenting with suspected preterm labour actually deliver preterm.
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Others
Inaugural College of Obstetricians & Gynaecologists Lecture: Recent Developments in Obstetric Care and Maternal Fetal Medicine in Singapore
Has it done any good to pregnancy outcome as promised?
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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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Original Article
Tailoring the Field and Indication of Adjuvant Pelvic Radiation for Patients with FIGO Stage Ib Lymph Nodes-Negative Cervical Carcinoma Following Radical Surgery Based on the GOG Score – A Pilot Study
Although no significant survival difference exists between primary surgery and radiotherapy (RT) for the treatment of FIGO stage Ib cervical cancer, radical surgery is the preferred modality of treatment as conservation of the ovarian and vaginal function is of prime importance. It also allows the study of prognostic histopathological...
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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Review Article
Marijuana in Pregnancy
Marijuana has been used for thousands of years for both medical and recreational purposes. Because the pharmacological actions of marijuana are complex and include a unique blend of effects of alcohol, opioids, tranquilisers and hallucinogens, the clinical picture could be very unpredictable and the diagnosis is often difficult.
This article...
Original Article
Abnormal Liver Function Tests in the Symptomatic Pregnant Patient: The Local Experience in Singapore
The diagnostic work-up of abnormal liver function tests (LFT) in pregnancy is challenging, as the conditions peculiar to pregnancy have to be considered in addition to the causes affecting the non-pregnant population. The spectrum of disease is varied and the abnormal LFT can be mild with no long-term consequence,...
Original Article
Twin Births in Singapore: A Population-Based Study Using the National Birth Registry
Twin studies are regarded as one of the better ways to study the effects and significance of gene, environment and interactions of both. The study of monozygotic (MZ) and dizygotic (DZ) twins allows for an estimation of the relative importance of genes and environment.
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Original Article
The Effectiveness of Transvaginal Anterior Colporrhaphy Reinforced with Polypropylene Mesh in the Treatment of Severe Cystoceles
Using the Baden-Walker halfway system, Grade 4 cystoceles are defined as extrusions of the bladder base beyond the vaginal introitus with patient straining maximally and represent the extremes of anterior vaginal wall prolapse (Table 1). They result from increased laxity and weakness of the urethrovesical supporting system comprising the...
Others
Book Review
This handbook is written by 3 obstetricians and gynaecologists based at the KK Women’s & Children’s Hospital, Singapore. It is an excellent book that answers the everyday questions that general practitioner (GP) will ask in their clinical practice.
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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%...
Original Article
Right Atrial Isomerism – Preponderance in Asian Fetuses. Using the Stomach-distance ratio as a Possible Diagnostic Tool for Prediction of Right Atrial Isomerism
Atrial isomerism is a disorder of lateralisation characterised by symmetric development of normally asymmetric cardiac atria and organ systems. The synonyms for these defects include heterotaxy syndrome, polysplenic/ asplenic syndrome, right/left isomerism, isomerism of the atrial appendages and situs ambiguous.
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Letter to the Editor
Assessment of Medical Graduates Competencies
Medical professional proficiency comprises a set of skills, knowledge, and attitudes necessary to efficiently accomplish the practice of medicine. The major aim of undergraduate medical education in the region is to produce doctors who are competent and able to meet the health needs of the community while also being...
Letter to the Editor
Chylous Ascites in Recurrent Gynaecological Malignancies
Chylous ascites is an unusual phenomenon where there is accumulation of chyle in the peritoneal cavity. It is especially rare following treatment of gynaecological cancers.
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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.
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Others
Holoprosencephaly: An Antenally-diagnosed Case Series and Subject Review
Holoproscencephaly (HPE) is an uncommon congenital developmental defect of the forebrain structures to divide into separate hemispheres and ventricles during embryogenesis. The prevalence rate of HPE is estimated to be between 1 in 11,000 to 1 in 20,000 live births, and 1 in 250 during early embryogenesis.
This article is...
Letter to the Editor
Laparoscopic Heller’s Cardiomyotomy for Achalasia of the Cardia in a Pregnant Patient
Laparoscopy was first used for the evaluation of acute abdominal pain in pregnancy by gynaecologists in 1980. The most commonly reported laparoscopic procedure during pregnancy is laparoscopic cholecystectomy.
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Letter to the Editor
Spontaneous Vaginal Expulsion of a Filshie Clip
Laparoscopic sterilisation is a common method of permanent contraception. The Filshie clip system is a safe and effective method of female sterilisation.
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Review Article
Care of Women in Menopause: Sexual Function, Dysfunction and Therapeutic Modalities
Menopause is a life change described by biological alterations occurring in the context of important social changes. There is an increasing appreciation for the role of sexual function in menopause and its importance for a woman’s health and well-being.
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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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Review Article
Menopause, Hormone Therapy and Cardiovascular and Cerebrovascular Disease
Cardiovascular disease is a major cause of morbidity among postmenopausal women. Up to the age of 50 years, the prevalence of coronary artery disease (CAD) among women is lower than among men, but the incidence rises significantly after the menopause.
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Original Article
The Influence of Maternal Ethnic Group and Diet on Breast Milk Fatty Acid Composition
Human milk is the ideal food which provides the complete nutritional requirements for infants during the first 6 months of life. The lipids accumulated in an infant represent the majority of all energy retained in the growing tissues during this crucial period of rapid growth and development.
This article is...
Original Article
A Clinicopathologic Study of Uterine Smooth Muscle Tumours of Uncertain Malignant Potential (STUMP)
Smooth Muscle Tumours of Undetermined Malignant Potential or STUMPs are interesting tumours from both the standpoint of histological diagnosis and classification as well as clinical management mainly because, as a group, its natural history is poorly understood. Prognostic criteria of how STUMP tumours will behave have been studied and...
Original Article
Obstetric Outcomes of Influenza A H1N1 (2009) Infection in Pregnancy – Experience of a Singapore Tertiary Hospital
Influenza A H1N1 (2009) is a new viral strain containing gene segments from human, swine and avian lineages. Soon after reports of human cases of the infection in April 2009, the World Health Organization declared the situation a public health emergency of international concern.
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Others
Inadvertent Use of Bevacizumab to Treat Choroidal Neovascularisation During Pregnancy: A Case Report
The recognition that vascular endothelial growth factor (VEGF) plays an important role in the pathogenesis of neovascular age-related macular degeneration (NVAMD) has led to the development of several intravitreal anti-angiogenic therapeutics. Ranibizumab (Lucentis, Genentech, San Francisco, USA) and pegaptanib (Macugen, OSI/Eyetech Pharmaceuticals, New York, USA) have been FDA-approved for...
Original Article
Emerging Trends in Breastfeeding Practices in Singaporean Chinese Women: Findings from a Population-based Study
The health benefits of breast milk have been well documented, with positive implications for infants’ metabolic, immunologic, respiratory and digestive health. The World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breastfeeding for 6 months and partial breastfeeding thereafter for at least 12 or 24 months....
Letter to the Editor
Dilemmas in Management of Brain Tumours in Pregnancy
Brain tumours in pregnancy are rare with an incidence of 15 per 100,000 and previous reports have shown variable outcomes. We present a case of glioblastoma multiforme (GBM) in pregnancy in which the patient underwent emergency craniotomy and adjuvant radiotherapy before delivering a healthy baby with good outcome.
This article...
Others
A Unique Pair of Monozygotic Twins with Concordant Clear Cell Renal Cell Carcinoma: A Case Report
Studies of monozygotic and dizygotic twins represent an important approach in estimating the relative contributions of genes and environment to the development of various cancers and disease in general. However, remarkably and almost curiously, there has been no monozygotic twin-pair concordant for clear cell renal cell carcinoma (ccRCC) reported...
Original Article
Clinical Outcomes of High-risk Labours Monitored Using Fetal Electrocardiography
Intermittent auscultation (IA), cardiotocography (CTG), amniotic fluid colour and fetal scalp capillary blood gas analysis are currently accepted standards for intrapartum fetal monitoring. According to the results of recent randomised clinical trials, intrapartum CTG monitoring is a very sensitive method; however, its very low specificity seems to be strongly...
Original Article
Microsurgical Reversal of Sterilisation – Is This Still Clinically Relevant Today?
Different contraceptive options are available today; however, tubal sterilisation is still one of the most prevailing contraceptive alternatives. Locally, many prefer mechanically occluding the tubes with Filshie clips.
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Original Article
Gynaecologic Robot-Assisted Cancer and Endoscopic Surgery (GRACES) in a Tertiary Referral Centre
Hysterectomy is the most common major gynaecologic operation. Over 600,000 hysterectomies are performed annually in the US. In Singapore, almost 9000 hysterectomies are performed annually. Traditionally, gynaecologic surgeons approached the pelvis through a laparotomy incision. Since its introduction some 20 years ago, laparoscopy has become the preferred option compared...
Letter to the Editor
Misdiagnosis of a Large Uterine Vein Thrombosis as a Uterine Myoma Prior to Hysterectomy: A Case Report
Dear Editor,
Intravascular thrombosis is a serious problem that sometimes causes death due to acute pulmonary thromboembolism (PTE). There are a few reports on the association between uterine myomas and venous thromboembolic diseases and ovarian vein thrombosis
after cesarean delivery, but reports of uterine vein thrombosis without complications are rare. We...
Original Article
Comparison of Growth Parameters of 5-year-old Singleton Children Born in Assisted Versus Natural Conception
The first successful birth resulted from in-vitro fertilisation (IVF) was reported in 1978.1 Today this technology is being used worldwide and currently, approximately 1% of live births of the world are conceived via assisted reproductive technologies (ART), which include IVF and intracytoplasmic sperm injection (ICSI).
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Editorial
Obstetricians, Perhaps It’s Time to Change Lenses
Times have changed. Maternal mortality rates at the start of the 1900s were around 1 in 100 live births in the best maternity institutions. This has declined by around 3 orders
of magnitude in the last 100 years to about 3 in 100,000 live births in places like Singapore. Perinatal...
Original Article
Get “Real” with Hysteroscopy Using the Pig Bladder: A “Uterine” Model for Hysteroscopy Training
Hysteroscopy is an important surgical component of any training programme in gynaecology. Traditionally, surgical training in hysteroscopy occurred in the operating room where trainees first observe their senior performing the procedure, and then take on increasing roles in surgical cases under direct supervision. Often, hysteroscopic skills
are acquired via a...
Original Article
Neonatal Outcome of the Late Preterm Infant (34 to 36 Weeks): The Singapore Story
Neonatologists were caught looking the other way in the early part of the millennium. While they were keenly following the progress of extreme preterms and their travails, preterms born at the other end of the spectrum were being quietly ignored as “well babies”. In July 2005, the National Institute...
Original Article
Are Pregnant Women Adequately Equipped for Autonomy in Pregnancy Screening?
The concept of first trimester screening (FTS) to evaluate the risk of fetal aneuploidies was first introduced in 1997 by Orlandi et al. The Fetal Medicine Foundation, London, has refined and populated this screening test that uses a combination of maternal age, nuchal translucency (NT) thickness and biochemical markers,...
Letter to the Editor
Prevalence of vitamin D deficiency and insufficiency in Malaysian infants
Vitamin D deficiency, a worldwide health problem, is also prevalent in tropical countries. It is estimated that 15% of the world’s population are either vitamin D deficient or insufficient. In a study on the state of Kelantan in Malaysia (2010–2012), 60% of pregnant women were vitamin D deficient. Maternal...
Letter to the Editor
Maternal obesity and risk of adverse obstetric outcomes in Malaysia
Obesity during pregnancy is associated with increased risk of adverse health outcomes such as gestational diabetes mellitus (GDM), hypertension and preeclampsia. Unlike the well-known association between maternal hyperglycaemia and pregnancy outcomes, the effect of obesity in pregnancy has drawn some controversial conclusions.1Data are even scarcer in Southeast Asia countries....
Letter to the Editor
Importance of antenatal blood group typing and antibody screening in non-ABO/Rh haemolytic disease of the newborn
Haemolytic disease of the fetus and newborn (HDFN) is a severe, potentially fatal alloimmune condition where maternal antibodies are produced, transported across the placenta and react against fetal red blood cell (RBC) antigens, resulting in varying degrees of haemolytic anaemia. Although ABO and Rhesus D (RhD) incompatibility is responsible...
Editorial
Uterine rupture in Singapore: Trends and lessons learnt
Uterine rupture is arguably one of the most dreaded acute obstetric complications in obstetrics. Synonymous with significant maternal and perinatal morbidity and mortality risks, uterine rupture is usually encountered in the context of vaginal births after previous caesarean section (VBAC).
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Original Article
Cervical screening in foreign domestic workers in Singapore
Cervical cancer is the most common gynaecological cancer in many countries in Southeast Asia, with a cumulative age-standardised incidence rate (ASRI) of 17.2 per 100,000 and a corresponding mortality rate (ASMR) of 10 per 100,000. In Singapore, cervical cancer is the 10th most common cancer in women with an...
Original Article
Risk factors and outcomes of uterine rupture in Singapore: Emerging trends
Uterine rupture is a catastrophic life-threatening complication of pregnancy with associated high maternal and neonatal morbidity and mortality. The incidence of uterine rupture varies with geographical location and obstetric practice. With the changes in obstetric practice over the years, caesarean section rates have increased in our population with undesirable...
Original Article
A Pilot Study of the Efficacy and Tolerability of Intralesional Recombinant Human Beta-Interferons in Cervical Intraepithelial Neoplasia
Cervical intraepithelial neoplasia (CIN) is a neoplastic disorder in which infection with sub-types of the human papillomavirus appears to play an important aetiological ro1e. The interferons are a family of proteins which possess anti-viral action, inhibit cell proliferation and modulate the natural immune response2 and which therefore may be...