[metaslider id="5280"]

Related Articles

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...

Safe time interval for screening estimated glomerular filtration rate prior to gadolinium-enhanced MRI scan

Dear Editor, Magnetic resonance imaging (MRI) contrast media are commonly used in medical imaging and are usually gadolinium-based contrast agents (GBCAs). They can be divided...

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...

The Lancet Commission on diagnostics: What it means for Singapore

Effective healthcare systems depend on a functioning healthcare value chain—defined as a care cascade comprising screening, diagnosis, treatment and follow-up. The tremendous heterogeneity and...

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...

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...

Reduction in Retake Rates and Radiation Dosage Through Computed Radiography

New computed radiography imaging systems are slowly gaining a foothold in radiological departments worldwide. By computed radiography we mean a digital imaging system which...

Computed Tomographic and Magnetic Resonance Imaging Findings in Paranasal Sinus Involvement in Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is an aggressive infiltrative neoplasm. Spread into the paranasal sinuses is often seen but the frequency is documented in only a...

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...

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 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...

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. This article is...

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. This article is...

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...

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%. This article...

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. This 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) This article is available only as...

Fallopian Tube Carcinoma—A Review

Fallopian tube cancer is the least common of gynaecological malignancies. It was first described by Renaud in 1847. This article is available only as a...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Book Review

This book is a collection of 30 case studies, which were published in the Singapore Medical Journal from 1994 to 1997. They include interesting...

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...

Bone Mineral Density—Correlation between Quantitative Ultrasound Characteristics and Dual Energy X-ray Absorptiometry

Osteoporosis is well documented to be a significant determinant of the risk of fracture and its assessment in vivo has been based on various...

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...

A Review of the Role of Magnetic Resonance Imaging in the Evaluation of Shoulder Impingement Syndrome and Rotator Cuff Tendon Tears

In the evaluation of chronic shoulder pain and dysfunction clinically suspected to be due to shoulder impingement syndrome and rotator cuff tendon tears, magnetic...

Portable Chest Radiography: Comparison of High-resolution Digital Displays with Laser Printed Digital Film

In most institutions, about 10% to 25% of imaging examinations are recorded digitally (e.g. digital subtraction angiography, computed tomography, magnetic resonance imaging and ultrasound)....

Percutaneous Needle Aspiration in the Treatment of Hepatic Abscess: Factors Influencing Patients’ Outcome

Liver abscess traditionally has been treated by open surgical drainage, mortality rates being as high as 80% to 100% if left untreated. However, with...

Contrast-Enhanced Magnetic Resonance Imaging of the Internal Auditory Canals and Posterior Fossa

Contrast-enhanced magnetic resonance imaging (MRI) is now the gold-standard examination for the exclusion of acoustic schwannomas or other posterior fossa tumours. We retrospectively reviewed...

Imaging of Thoracic Manifestations of Scleroderma

Systemic sclerosis (SScl) is a generalised disease of the connective tissue characterised by fibrosis and vascular changes affecting the skin, lungs, gastrointestinal tract, kidneys,...

Overview of Imaging in Rheumatologic Diseases

Since the discovery of X-rays over a century ago, radiology has played a pivotal role in rheumatology and diseases of the joints. The innovations...

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....

Magnetic Resonance Imaging of Brain Metastases: Magnetisation Transfer or Triple Dose Gadolinium?

Accurate detection of brain metastases is an important part of tumour staging. Magnetic resonance (MR) imaging is well accepted as a sensitive tool in...

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...

Radiological Placement of 211 Central Venous Catheters: Outcome and Complications

Long-term central venous access is an important part of modern medical practice, especially in the haematology and oncology units. Central venous (CV) catheters are...

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...

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...

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....

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...

Tissue Microangiography Using a Simplified Barium Sulphate Cadaver Injection Technique

The understanding of blood supply is the cornerstone of successful tissue transfer in reconstructive surgery. This understanding has been derived largely from cadaveric dissections,...

Radionuclide Studies of Articular Cartilage in the Early Diagnosis of Arthritis in the Rabbit

Osteoarthritis is a common joint disease that involves destruction of articular cartilage. Magnetic resonance imaging (MRI) provides a sensitive imaging modality for the diagnosis...

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...

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. This article...

Evaluation of Technetium-99m Ciprofloxacin (Infecton) in the Imaging of Infection

Over the past 10 years we have used various radiopharmaceuticals (RPCs) for imaging of inflammation and infection. These include gallium-67 citrate and the technetium-99m...

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...

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...

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...

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....

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...

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...

Magnetic Resonance Arthrography of the Labral-Ligamentous Complex of the Shoulder: An Update

Shoulder instability is a frequently encountered clinical problem in young active people following injury, particularly in athletes. The labral-ligamentous complex is increasingly recognised as...

Limited Magnetic Resonance Imaging (MRI) and the Occult Hip Fracture

Worldwide, in the past decade, the application of magnetic resonance imaging (MRI) has increased tremendously in the management of musculoskeletal trauma. Not least is...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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....

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...

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...

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...

Technetium-99m Methoxyisobutylisonitrile Imaging in the Follow-up of Differentiated Thyroid Carcinoma

Differentiated thyroid carcinoma (DTC) is not an uncommon tumour in Thailand.1 A high percentage of 10-year survival results in long-term follow-up. I-131 total-body scan...

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...

Single Centre Review of Radiologically-guided Percutaneous Nephrostomies: A Report of 273 Procedures

Percutaneous nephrostomy (PCN) is a well-established technique in the armamentarium of an interventional radiologist when dealing with urinary obstruction. It provides temporary relief in...

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...

To Establish the Normal Bone Mineral Density Reference Database for the Singapore Male

Bone mineral densitometry was developed as a means to quantify the bone mineral content of the skeleton accurately and has been used in the...

Percutaneous Vertebroplasty in the Management of Osteoporotic Vertebral Compression Fractures: Initial Experience

With the general increase in life expectancy in the local population, the incidence of osteoporosis is anticipated to rise as well. Even with screening...

Differentiation of Malignant Vertebral Collapse from Osteoporotic and Other Benign Causes Using Magnetic Resonance Imaging

An elderly patient presenting with backache and vertebral collapse on plain X-ray is a common clinical scenario and a diagnostic challenge. It is difficult...

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...

Letter to the Editor

We would like to draw the attention of your readers to the comments made in the editorial of the recent Imaging issue of your...

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...

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...

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...

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...

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...

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,...

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

Imaging-guided Bone Biopsy

Biopsy may be performed at surgery (open biopsy) or percutaneously (closed biopsy). Percutaneous bone biopsies are usually performed under imaging guidance using a variety...

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...

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...

Radiographic Features of a Case of Severe Acute Respiratory Syndrome with Fatal Outcome

Severe acute respiratory syndrome (SARS) is an atypical pneumonia that was first reported in early 2003. Reports of outbreaks of cases rapidly appeared in...

Clinical Applications of MR Cholangiopancreatography

Magnetic resonance cholangiopancreatography (MRCP) has attracted a lot of interest from clinicians because it is a non-invasive method of obtaining a cholangiographic image without...

Imaging of Paediatric Mediastinal Masses

A review of mediastinal masses in children, emphasising imaging features, is important for several reasons. Firstly, the mediastinum is the most common location for...

Clinical Positron Emission Tomography Imaging—Current Applications

Like other radionuclide techniques, positron emission tomography (PET) is based on the tracer principle – a small amount of labelled ligand is used to...

MR Imaging and MR Spectroscopy of Adenocarcinoma of the Prostate

Prostate cancer is usually suspected due to an abnormal digital rectal examination, elevated serum prostate specific antigen (PSA) level or both. The diagnosis of...

Imaging of Congenital Middle Ear Deafness

When a child or young adult with morphologically normal external ears and no previous history of ear discharge or trauma presents with conductive hearing...

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. This article...

Imaging of Acquired Immunodeficiency Syndrome (AIDS)

The pandemic of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) is a global healthcare problem and HIV infection is the most common cause of...

The Singapore National Breast Screening Programme: Principles and Implementation

In January 2002, the first population-based national mammographic breast screening programme in Asia, the Singapore National Breast Screening Programme (BreastScreen Singapore), was launched. The...

Brachiocephalic-Superior Vena Cava Metallic Stenting in Malignant Superior Vena Cava Obstruction

A large majority of superior vena cava (SVC) syndrome is caused by malignancy (74% to 95%). This can either be due to direct SVC...

Pilot Study Using Technetium-99m Pertechnetate Sequential Radionuclide-Sialography to Assess Salivary Gland Function in Nasopharyngeal Cancer Patients on Radiation Therapy

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy occurring worldwide with particularly high frequencies in the Far East. The incidence is highest in Hong Kong...

Breath-hold Fast Recovery Fast Spin Echo versus Conventional Non-Breath-hold Fast Spin Echo T2-Weighted MR Imaging of Focal Liver Lesions

T2-weighted magnetic resonance (MR) imaging is an important sequence for characterisation of focal liver lesion. Accurate characterisation of benign lesions, such as haemangioma or...

Diffusion-weighted MR Imaging in Intracranial Infections

Diffusion-weighted magnetic resonance (MR) imaging (DWMRI) is becoming essential to the assessment of acute cerebral infarction and has also been applied to distinguish cerebral...

Preoperative High Resolution CT and MR Imaging in Cochlear Implantation

Candidates for cochlear implantation undergo a thorough audiological and medical assessment. The audiological assessment is done to ensure that these candidates who have bilateral...

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...

Breast Cancer in Women Under 40 Years: Preoperative Detection by Mammography

The incidence of breast cancer peaks between the ages of 45 and 55 years. Approximately 7% of breast cancers occur below 40 years of...

The Past Decade of Diagnostic Radiology in Singapore: How Much Progress Have We Really Made?

It has been 10 years since the first ever issue of Annals dedicated to “Radiology” was published in Volume 22 No. 5 September 1993....

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....

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...

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...

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...

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...

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...

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...

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...

Routine Abdominal and Pelvic Ultrasound Examinations: An Audit Comparing Radiographers and Radiologists

Since its introduction into clinical practice in the early 1970s, ultrasound (US) has become firmly established as an extremely valuable imaging modality and widely...

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...

Clinical Utility of Selective Intra-arterial Calcium-stimulated Hepatic Venous Sampling in Regionalisation of Insulinomas—The Singapore Experience

Insulinomas are small tumours with dimensions that seldom exceed 2.0 cm in diameter. Preoperative non-invasive localisation using trans-abdominal ultrasound and conventional computed tomography (CT)...

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...

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...

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

Reflections of a Septuagenarian – Radiology: Past, Present and Future

Before I commence, I would like to thank the Singapore Radiological Society and the Chapter of Radiologists of the Academy of Medicine for inviting...

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...

Audit of Diagnostic and Interventional Craniocervical Catheter Angiographic Procedures at the Singapore General Hospital

Catheter angiography has long been considered the diagnostic standard by which the accuracy of other vascular imaging modalities are compared, given its superior contrast...

Breast Ultrasound in Women With Familial Risk of Breast Cancer

Mammography is the modality of choice to screen for breast cancer in asymptomatic women. However, it is known that about 10% to 12% of...

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...

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...

Coronary Artery Disease: Comprehensive Evaluation by Cardiovascular Magnetic Resonance Imaging

Coronary artery disease (CAD) is a major health problem worldwide. With advances in CAD intervention and improvements in treatment and management of CAD, there...

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...

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

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...

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...

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...

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...

Semi-Quantitative Measurements of Normal Organs With Variable Metabolic Activity on FDG PET Imaging

Positron emission tomography (PET) has a proven clinical role in oncology, cardiology and neurology that primarily uses 2-deoxy-2--fluoro-deoxyglucose (FDG). FDG is an analogue of...

Clinical Applications of Positron Emission Tomography in Cardiology: A Review

Ischaemic heart disease associated with depressed left ventricular function is a common clinical management dilemma. There is overwhelming evidence that such patients have a...

The Role of FDG-PET in the Management of Non-small Cell Lung Carcinoma

Carcinoma of the lung is the leading cause of cancer death in both men and women and is the second most common malignancy in...

Clinical PET Imaging – An Asian Perspective

Positron emission tomography (PET) is distinct from other imaging modalities in its ability to probe the physiology and biochemistry of normal and abnormal tissues....

PET Tracers and Radiochemistry

Positron emission tomography (PET) has become a powerful scientific and clinical tool for probing biochemical processes in the human body. This is due, in...

Physical Principles and Technology of Clinical PET Imaging

The past few years have seen the transition of positron emission tomography (PET) from the research domain into mainstream clinical applications for oncology. The...

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...

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...

Use of D-dimer and Lower Extremity Doppler Ultrasound Results to Obviate the Need for Computerised Tomographic Pulmonary Angiography

The diagnosis of pulmonary embolism (PE) can be a challenging problem. It depends on clinical suspicion and the interpretation of a combination of clinical...

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...

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...

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...

Building Collaboration in Cardiac Imaging

Publicity about new developments in medical technology is not at all unusual. But the degree with which multi-slice computed tomography (MSCT) for coronary artery...

3rd FY Khoo Memorial Lecture – Education, Professionalism, Outsourcing and the Future of Radiology

Radiology is undergoing unprecedented changes. Not only is the technology evolving rapidly, providing images of breathtaking anatomical clarity, but functional information has also become...

Singapore National Medical Image Resource Centre (SN.MIRC): A World Wide Web Resource for Radiology Education

Radiological images are critical for diagnosis, teaching and research. In radiology education, learners must be exposed to large amounts of visual information, and assimilation...

Teleradiology in Singapore – Taking Stock and Looking Ahead

Teleradiology is the electronic transmission of radiologic images from one location to another for the purposes of interpretation and/or consultation. The current interest in...

Radiographic Features of SARS in Paediatric Patients: A Review of Cases in Singapore

Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). It is easily transmitted via droplet infection...

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...

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...

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...

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...

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...

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...

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...

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. This article is...

Magnetic Resonance Imaging of Sports Injuries of the Knee

Sports-related knee injuries are common, with contact sports and sports involving twisting movements being the most frequent causes. Sports injuries may affect any of...

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...

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...

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...

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...

Medical Misadventure: Barium Extravasation in Colorectal Cancer

Double contrast barium enema (DCBE) is a safe and accurate diagnostic procedure for colorectal cancer. It is often the next diagnostic test after incomplete...

Durian Seed Masquerading as Gallstone Ileus on Computed Tomography

Bezoars and gallstones are unusual causes of small bowel obstruction, with well-described imaging features on CT. We present a case of intestinal obstruction caused...

A Survey of Local Preclinical and Clinical Medical Students’ Attitudes towards Radiology

Radiology is not a popular specialty for undergraduate student electives or postgraduate training amongst students from a local undergraduate medical school which is based...

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...

Primary Epithelioid Angiosarcoma of the Lung Presenting as Left-sided Shoulder Pain

Primary angiosarcoma of the lung is a rare, often difficult to diagnose disorder with non-specific respiratory manifestations. Angiosarcoma involving the lung is usually a...

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...

Macronodular Tuberculosis: Imaging Resemblance of Cholangiocarcinoma

The ability of multiphasic computed tomography (CT) and magnetic resonance (MR) studies in the diagnosis of liver tumours such as hepatocellular carcinoma and cholangiocarcinoma...

Central Clot Score at Computed Tomography as a Predictor of 30-day Mortality after Acute Pulmonary Embolism

Multi-detector Computed Tomography (MDCT) pulmonary angiography is currently the method of choice for the detection of acute pulmonary embolism (PE), because of its convenience,...

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...

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...

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...

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...

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...

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...

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...

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...

Periarticular FDG Uptake on PET/CT in Malignant Melanoma—Metastatic or Misleading?

A 74-year-old male with newly diagnosed melanoma of the right mastoid region, underwent resection of the lesion followed by F-18 fluoro-deoxyglucose (FDG) positron emission tomography/computed...

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...

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%...

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....

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...

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...

Ultrasound-Guided Thyroid Fine Needle Aspiration Biopsy—The Way Forward

I read with great interest the recent article published in the Annals of Academy of Medicine Singapore entitled, ‘Surgeon-Performed Ultrasound-Guided Fine Needle Aspiration Cytology...

Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms

Benign prostatic hyperplasia (BPH) is one of the commonest diseases of ageing men. It can be associated with bothersome lower urinary tract symptoms (LUTS)...

Prenatal Diagnosis of Chromosomal Abnormalities—Shifting Paradigm

It is very likely that in 10 years time, invasive prenatal diagnostic tests like amniocentesis and chorionic villus sampling (CVS) will join the club...

A Follow-up Longitudinal Survey on a Cohort of Undergraduate Medical Students’ Attitudes towards Radiology

As a follow-up to an earlier study comparing the attitudes of first year undergraduate medical students following the introduction of a new radiology curriculum...

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...

Transthyretin amyloid cardiomyopathy: The emerging role of cardiac amyloid imaging

Transthyretin amyloidosis (or ATTR amyloidosis) is an under-recognised multisystemic disorder, arising from misfolding of transthyretin proteins into insoluble amyloid fibrils. As amyloid fibrils deposit...

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...

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...

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...

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,...

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...