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TB or not TB? The axillary lump question
Clement Wenhao Chan, Benjamin Ruimin Poh, Chow Yin Wong, Raymond Yung Chien Kwah, Lester Chee Hao Leong
An 81-year-old woman of healthy weight presented with a 2-week history of a painless right axillary lump. Physical examination revealed a 2cm firm nodule...
An initial experience with laser haemorrhoidoplasty in addition to mucopexy for symptomatic haemorrhoids
Ying Xin Low, Frederick Hong-Xiang Koh, Winson Jianhong Tan, Sharmini Su A Sivarajah, Leonard Ming-Li Ho, Min-Hoe Chew, Fung-Joon Foo
Dear Editor, Symptomatic haemorrhoids is the most common anorectal disorder, where up to 75% of people experience symptoms sometime in their lives.1 The current gold standard...
Mesothelial Splenic Cyst—A Case Report
V R Reddi, M K Reddy, B Srinivas, C C Sekhar, O Ramesh
Non-parasitic cystic lesions of the spleen are unusual. They are classified essentially as primary (true, epithelial) and secondary (pseudo, non-epithelial) based on the presence...
A Case Report of Neutrophilic Eccrine Hidradenitis in a Patient Receiving Chemotherapy for Acute Myeloid Leukaemia
G C Wong, L H Lee, Y Y Chong
Neutrophilic eccrine hidradenitis (NEH) is a neutrophilic dermatosis primarily affecting the eccrine glands and occurs most commonly in patients undergoing chemotherapy for a malignancy. This...
Abdominal Surgery in Human Immunodeficiency Virus (HIV) Infected Patients—Early Local Experience
E Foo, R Sim, H Y Lim, S T F Chan, Y S Leo, S Y Wong
The prevalence of human immunodeficiency virus (HIV) infection is rising at an exponential rate in Singapore. The surgical experience with this disease remains limited. This...
Adjuvant Chemotherapy for Patients with Resected Dukes' C and High-risk B2 Colon Cancer with Fluorouracil and Levamisole
E Au, P T Ang, F Seow-Choen, K C Soo, C H Low, H C Chng, B K Ng
Carcinoma of the large bowel is the second leading cause of cancer mortality in Singapore. Although the great majority of patients are discovered at...
Experience with a Nine-step Policy Dealing with Requests for Medically Inappropriate Interventions for Cancer
R D Pentz
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
W P Soutter
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
C Quek, T Mould, K Canfell, A Singer, V Skladnev, M Coppleson
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
K C Loh, J C Lo, C J Zaloudek, P A Fitzgerald
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 Khalid, F Lawton
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...
A Case Report—Delayed Vesicocutaneous Fistula After Radiation Therapy for Advanced Vulvar Cancer
K O Lau, C Cheng
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
A Ilancheran
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
P Ng, F Lawton
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
N F Hacker
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
C F Verschraegen, A P Kudelka, J J Kavanagh
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
N D MacDonald, A N Rosenthal, I J Jacobs
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
I Busmanis
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?
M H Jones
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
M A Quinn
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
F K Lim, B Chanrachakul, S M Chong, S S Ratnam
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
Y Shimizu, S Umezawa, K Hasumi
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
S K Tay, M D Thilagam
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
T H Ho, T L W Lim, H S Khoo Tan
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
K M Lee, H S Khoo Tan, M K S Leow, V K Sethi, E J Chua
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
K O Lau, T N Hia, C Cheng, S K Tay
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
M Yegappan, Y H Ho, D Nyam, A Leong, K W Eu, C Seow
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
V Sivanesaratnam
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
H S Khoo Tan, K M Lee, V K Sethi, E J Chua
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
S K Tay, L K Tan
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
S K Tay
Cancer of the pelvic reproductive organs and external genitalia accounts for one in six cancers in women. It can occur in women of all...
The Sixth SGH Lecture—Singapore: A New Venice of the 21st Century
T Koh
Venice is one of the legendary cities of the world. Its beauty and physical setting make Venice unique. For almost 800 years, from 1000...
Ambulatory Anorectal Surgery—Is it Feasible Locally?
E Foo, R Sim, H Y Lim, S T F Chan, B K Ng
Economic and social pressures are compelling surgeons to modify their practice. An increasing number of procedures are being done in an outpatient setting. This article...
Phyllodes Tumour: An Update of 40 Cases
P T C Iau, T C Lim, D J C Png, W T L Tan
First described by Johannes Muller in 1838 as a large, benign tumour of the breast. Phyllodes tumour is a rare pathological entity, accounting for...
The Investigation and Management of Thyroid Nodules—A Retrospective Review of 183 Cases
W Y Chiu, N H Chia, S K Wan, C H Yuen, M T Cheung
Thyroid nodule is a common problem in surgical practice. In 1994, more than 350 thyroid operations were performed in our department, of which 183...
The Role for Preoperative Localisation Techniques in Surgery for Hyperparathyroidism
H N Koong, L H L Choong, K C Soo
Hyperparathyroidism is well recognised as a clinical problem that has a myriad of presentation. The classical presenting symptoms of hypercalcaemia have been well documented...
Medicine and Surgery—History, Change and Challenge
K Soin
Mr Koh Yong Guan, guest-of-honour; Dr Tan Ser Kiat, Master, Academy of Medicine; Dr K C Tan, Chairman, Chapter of Surgeons; Dr Robert Jalleh...
Current Continuing Medical Education Provision in Singapore
Y C Chee
It was in 1994 that as an overseas fellow of the College, I received a letter from Dr Peter Toghill, Director of Continuing Medical...
Early 21st Century Professional Practice: Change and Challenge
Today is a day of rejoicing for all of you, graduates, parents, relatives and loved ones. I can share in your joy and also...
9th Seah Cheng Siang Memorial Lecture: Gastric Cancer—Where are we now?
S K Lam
The last two decades have witnessed dramatic changes in the understanding of gastric cancer: a rapid decline in global incidence, its association with Helicobacter...
Haemorrhage into Non-functioning Adrenal Cysts—Report of Two Cases and Review of the Literature
S P Chew, R Sim, T A Teoh, C H Low
Doran, in 1903, reported the first case of adrenal cyst described by Greiselius in 1670. It was not until 1966 that Foster reported the...
Video-assisted Thoracoscopy: Role in the Management of Intrathoracic Pathology
K P L Yap, N C Tan
Thoracoscopy was first introduced by Jacobaeus nearly a century ago. With the development of endoscopic equipment and the recent surge of interest in minimally...
Focused Abdominal Sonography for Trauma (FAST)
A Yeo, C Y Wong, K C Soo
The multiply injured patient presents a challenge to even the most experienced surgeon. These patients often present in shock and require a rapid diagnostic...
New Treatment and Research Strategies for the Improvement of Care of Cleft Lip and Palate Patients in the New Millennium
S T Lee
I have chosen as the title of my keynote address "New Treatment and Research Strategies for the Improvement of the Care of Cleft Lip...
Life-threatening Perineal Gangrene from Rectal Perforation Following Colonic Hydrotherapy: A Case Report
M P C Tan, D M O Cheong
Alternative medicine has become widely publicised throughout the world. Alternative medicine practitioners (AMPS), which include Oriental medicine doctors, traditional Chinese medicine practitioners, naturopaths and...
Concurrent Chemoradiotherapy in Patients with Locally Advanced Nasopharyngeal Carcinoma of the Undifferentiated Type
Y K Ong, E H Tan, J Wee, C B Goh, K W Fong, K S Lee, E J Chua
Nasopharyngeal carcinoma (NPC) of the undifferentiated type has a unique geographic distribution and is rather different, biologically and aetiologically, from squamous cell cancer of...
Diagnosing and Managing Faecal Incontinence
K S Ho, Y H Ho
Faecal incontinence is the inability to control the passage of gas, liquid or solid through the anus. Its severity varies from infrequent passage of...
Cancer Gene Therapy—Fantasy or Foresight?
H L Kong
Genes define life, at least in its biological sense. The prospect of being able to manipulate human biological processes through genetic engineering understandably evokes...
A Preliminary Study of the Immunohistochemical Detection of a Novel Tumour Marker, 22-1-1 Antigen, in Gynaecological Cancer Specimens
K Razvi, K Sonoda, Y S Lee, K F Tham, F K Lim, E L Yong
Monoclonal antibodies expressed against specific tumour cells can play a useful role in the study and management of such cancers. Such antibodies have been...
Young Investigator's Award: Induction of Apoptosis Following Traumatic Head Injury in Humans
I Ng, T T Yeo, R Soong, W T Tang, P L Ong, T Lew, H S Goh, D Smith
The outlook for sufferers of severe head trauma is extremely poor. Some 20% of patients died before significant treatment can be administered, and nearly...
8th Seah Cheng Siang Memorial Lecture: New Antithrombotic Agents
M Verstraete
The tremendous interest in finding new anti-aggregating agents stems from the preeminent role that platelets play, not only in haemostasis and thrombosis, but also...
3rd Yahya Cohen Lecture: The Role of the Myofibroblast-Like Cell in Hepatocellular Carcinoma—Host Defence?
L L P J Ooi
It is indeed a great honour for me to be named the third Yahya Cohen lecturer and I would like to express my deepest...
1998 Distinguished Academician Lecture: Hepatic Resection— A Western Perspective
R W Strong
Although debridement of portions of liver that prolapsed through war wounds was recorded from distant times, attempts at resection of a solid liver tumour...
1998 Runme Shaw Memorial Lecture: Somatic Evolution of Cancer
W F Bodmer
The interpretation of cancer as a somatic evolutionary process involving genetic mutation followed by selection, goes back to the early years of this century....
14th Gordon Arthur Ransome Oration: Continuity and Change
Deputy Prime Minister Lee Hsien Loong, Datuk Dr Yeoh Poh Hong, Dr Chee Yam Cheng, distinguished guests, ladies and gentlemen, I am deeply honoured...
The Future of Medicine from the Standpoint of the Practising Paediatrician
H B Wong
From the time of recorded history of medicine, the doctor whether he be the ancient healer or the modern medical practitioner, the doctor had...
Prognostic Factors in Endometrial Carcinoma
S H Chew
In the United States of America, endometrial carcinoma is the most common cancer of the female genital tract and has an annual incidence of...
Continuous Infusion 5-fluorouracil as Salvage Chemotherapy in Patients with Advanced Colorectal Cancer
W T Lim, W H Koo, E Au, K S Khoo
Studies have shown beyond doubt that chemotherapy for metastatic colorectal cancer prolongs survival, impedes progression and stabilises disease. Compared with supportive care alone, it...
A Practical Technique of Colour Image Analysis: Applications in Experimental Research
P K H Chow, T H Ng, M Chew, I C Song, H C I Kee, P O P Mack
Colour image analysers have been extensively used in medical research since 1970 for histomorphometric studies. Image analysis gives more information and a better understanding...
Effect of Antiangiogenic Agents on Experimental Animal Models of Hepatocellular Carcinoma
L X Qin, Z Y Tang, X M Li, W Bu, J L Xia
Metastatic spread is the principal reason of treatment failure in solid tumours. Surgery, radiation therapy and chemotherapy have not manifestly altered the prognosis for...
Immunological Consequences of Trauma and Shock
R A Catania, I H Chaudry
Despite intensive research and intervention, trauma continues to be the leading cause of death during the first three decades of life in the USA,...
Murine Metastatic Tumour Models for Cancer Gene Therapy Research
In the evaluation of any new cancer treatment, the use of appropriate experimental animal tumour models to bridge the gap between in vitro discovery...
An Animal Model for the Study of Hepatic Stellate Cell and Hepatocellular Carcinoma Interaction
L L P J Ooi, B H Bay, R T H Ng, I C Song, P O P Mack
Hepatic stellate cells (HSC) are mesenchymal cells that are prominent in various forms of liver injury, in particular with cirrhosis or carbon tetrachloride-induced fibrosis....
Synergistic Effect of Hepatitis B Virus and Aflatoxin B1 in Hepatocarcinogenesis in Tree Shrews
Y Li, J J Su, L L Qin, C Yang, K C Ban, R Q Yan
Primary hepatocellular carcinoma (HCC) is one of the commonest cancers in some parts of the world including several areas in China. The geographically distinct...
The Expression of Insulin-like Growth Factor II, Hepatitis B Virus X Antigen and p21 in Experimental Hepatocarcinogenesis in Tree Shrews
J J Su, G Z Qin, R Q Yan, D R Huang, C Yang, P D Lotlikar
Hepatocarcinogenesis is a multistage and multifunctional process. Epidemiological studies indicate that contamination of food with aflatoxin B, (AFB,) and chronic infection with hepatitis B...
The Viability of Liver Graft for Transplantation After Prolonged Warm Ischaemia
H S Ong, K C Soo, V T Joseph, S Y Tan, P R Jeyaraj
Liver transplantation (LTx) is the treatment of choice for many patients with end stage liver disease. However liver allograft availability prevents its widespread application. This...
Extended Resection of Locally Advanced (T4) Stomach Cancer
W S Yong, W K Wong, H S Chan, K C Soo
Cancer is the most common cause of death in Singapore. Although there is a gradual decline in incidence of stomach cancer over the years,...
Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty: An Audit of the Early Postoperative Results of 100 Consecutive Repairs
H Lau, F Lee, N G Patil, W K Yuen
Inguinal hernia is one of the commonest surgical pathologies in the world. Laparoscopic totally extraperitoneal repair has been gaining popularity in recent years. This article...
Design of Phase I and II Clinical Trials in Oncology and Ethical Issues Involved
B C Goh
Drug development is costly and time-consuming in terms of economic, patient and research resources. An integrated effort involving academia, industry, and regulatory authorities is...
Address by the Master, Academy of Medicine, Singapore at the 2000 Annual Induction Dinner—Learn the Past, Ensure the Future
I am delighted to share this celebratory occasion with you. It is a time for congratulations all round not only to our new Fellows...
Response by the Representative of Inductees, Academy of Medicine, Singapore at the 2000 Annual Induction Ceremony—A Call to Patient Advocacy
M Tan
I count myself fortunate to be allowed to join the ranks of the Academy. On behalf of my fellow inductees, may I extend a...
Address by the Master, Academy of Medicine, Singapore at the 2000 Annual Induction Ceremony—The EQ & IQ of Specialist Doctors
First, let me warmly welcome you to this pristine auditorium with its well preserved ceiling architectural details. Probably none of the new Fellows is...
8th SGH Lecture: Genomics, Talent and the Development of the Life Sciences Industry in Singapore
T K Y Tan
In a few months' time, one of the most significant advances, possibly the most significant advance ever in the history of biology and medicine,...
Perioperative Deaths: A Further Comparative Review of Coroner's Autopsies with Particular Reference to the Occurrence of Fatal Iatrogenic Injury
G Lau
Beginning in 1991, the Department of Forensic Medicine (DFM), which undertakes all Coroner's casework locally, embarked on an on-going review of Coroner's perioperative autopsies...
Spectrum of Abnormal Mammographic Findings and Their Predictive Value for Malignancy in Singaporean Women from a Population Screening Trial
K W E Sng, E H Ng, F C Ng, P H Tan, S C Low, G Chiang, G H Ho, L T Ng, C Wilde, K P Tan
While screening mammography can detect early breast cancers, a significant proportion of asymptomatic women are subject to unnecessary workup and surgery when biopsies for...
Hereditary Breast Cancer: A Brief Overview
J H Sng
Worldwide, breast cancer is the third most common form of cancer, after lung and stomach cancer, and it is the most common form among...
Update of Genetics in Colorectal Carcinomas: Genomic Instability and Somatic Evolution
P Y Cheah, K W Eu, F C Seow
The hypothesis that carcinogenesis occurs through stepwise accumulation of mutations1 has now been generally accepted. However, there is continual dispute over how carcinogenesis can...
3rd Tan Tock Seng Hospital Oration: The Changing Fabric of Medicine—An Ethical and Social Revolution
The legacy of Tan Tock Seng Hospital began with the founding of the Pauper Hospital in Pearl's Hill in 1844. This article is available only...
Microdochectomy for Single-duct Nipple Discharge
L Wong, Y F A Chung, C Y Wong
Nipple discharge is a common disturbing symptom for many women and often leads to a surgical referral. It accounts for 3% to 5% of...
Perioperative and Rehabilitative Outcomes after Amputation for Ischaemic Leg Gangrene
C W B Peng, S G Tan
In the last century, Sir William Ferguson said: "amputation—one of the meanest and yet one of the greatest operations in surgery: mean, where resorted...
Adverse Operative Risk Factors for Perforated Peptic Ulcer
W H Chan, W K Wong, L W Khin, K C Soo
Although there has been a significant decline in elective surgery for peptic ulcer disease with the introduction of H-2 blocker, the incidence of peptic...
10th Chapter of Surgeons' Lecture: The Challenges in Surgery—Past, Present and Future, and in Search of the 4Cs
C H Low
Firstly may I thank the Academy of Medicine and the Chapter of Surgeons for giving me this great privilege and honour to deliver the...
Opening Address by Dr Chee Yam Cheng, Master, Academy of Medicine, Singapore at the 33rd Annual Combined Surgical Meeting on 4 November 1999 at the COMB Auditorium
It is a pleasure to be present with you all at your 33rd Annual Combined Surgical Meeting for 1999 with less than 60 days...
Pseudomembranous Colitis in a Patient Treated with Paclitaxel for Carcinoma of the Breast: A Case Report
P Ang, W K Cheong, K S Khoo
Paclitaxel was discovered in 1963 as a crude extract from the bark of the pacific yew Taxus brevifolia. Since its development, a range of...
Early Hepatocellular Carcinoma Presenting with Biliary Ductal Invasion—A Case Report
J W H Leong, J M S Ho, H S Ng, J Prema Raj
Hepatocellular carcinoma (HCC) is a common malignant tumour worldwide. The local incidence of HCC is 40 per 100,000 in males and 20 per 100,000...
Results of Surgical Resection of Oesophageal Carcinoma in Singapore
W H Chan, W K Wong, H S Chan, K C Soo
Although the incidence of oesophageal carcinoma is declining, it still remains a common cancer in Singapore. From 1988 to 1992, it was the ninth...
Funding and Future Diagnosis Related Group Development
J C Vertrees
Supplement on Casemix Conference Singapore 2001 held on 17-19 August 2001 in Singapore This article is available only as a PDF. Please click on "Download...
Clinical Pathways or Case Management
D E Ariotti
Getting Clinicians Involved: The Australian Experience
M I Cleary
Pathology of Ductal Carcinoma In situ of the Breast: A Heterogeneous Entity in Need of Greater Understanding
P H Tan
Breast cancer is the commonest malignancy in Singapore women, with an age-standardised rate of 46.1 per 100,000 per year and an annual increase in...
Two Cases of Medullary Thyroid Carcinoma
M Jong, F X Sundram
A 44-year-old Indian man was found to have a raised carcinoembryonic antigen (CEA) (49.5 μg/L) detected on routine medical examination in February 2000....
Case Report: Follicular Adenoma in a Thyroglossal Duct Remnant Arising Entirely within the Hyoid Bone
G S W Chan, P H Tan, D T H Lim
Thyroglossal duct remnant is one of the most common lesions of the anterior midline neck. It occurs in 7% of adults1 and carcinoma is...
Digital Hand-held Sonography Utilised for the Focused Assessment with Sonography for Trauma: A Pilot Study
A W Kirkpatrick, R K Simons, D R Brown, A K T Ng, S Nicolaou
On a global basis, the use of ultrasonography to assist clinicians in obtaining timely diagnoses in abdominal trauma is not particularly new. The first...
The Alvarado Score and Acute Appendicitis
M Y P Chan, B S Teo, B L Ng
Acute appendicitis is a common surgical emergency. However, it is often difficult to make an accurate preoperative diagnosis, especially during the early stage of...
The 4th Tan Tock Seng Hospital Oration: Challenge for the Medical Profession in the 21st Century
P H Feng
I am greatly honoured to speak at the 4th TTSH Oration following such distinguished luminaries like Dr Chew Chin Hin, Dr Chen Ai Ju...
Intra-abdominal Hypertension—Implications for the Intensive Care Physician
G M Joynt, S J Ramsay, T A Buckley
Although the detrimental effects of raised intra-abdominal pressure have been known for over 100 years, it is only in the last two decades that...
Perioperative Treatment with Bactericidal/Permeability-Increasing Protein (rBPI21) in Major Liver Surgery: A Concise Summary
M J Wiezer, P G Boelens, R J C L M Vuylsteke, R J Nijveldt, C Meijer, M A Cuesta, S Meijer, P A M van Leeuwen
Primary and secondary hepatic malignancies constitute a major health problem. Hepatocellular carcinoma accounts for 90% of all primary hepatic malignancies in the world. While...
Alternate Modes of Financing Health Care Technology
A Grenvik
Alternative financing of health care delivery is one of the most vexing problems facing medicine today. Intensive care in many ways is a perfect...
Mucinous Cystadenoma of the Appendix—An Unusual Cause of Intestinal Obstruction
S J Chong, M Y P Chan
Mucinous cystadenoma of the vermiform appendix is an uncommon entity. It is a benign lesion but may disseminate and lead to the development of...
Primary Anorectal Malignant Melanoma: Clinical Features and Results of Surgical Therapy in Singapore—A Case Series
S Ooi, K W Eu, F Seow-Choen
Malignant melanoma arising from the anal canal was first described in 1857. It is uncommon, comprising only about 1% of all anal canal tumours. This...
2nd Chapter of Paediatricians Lecture: The Future of Paediatrics in Singapore
C L Tan
When I was first invited to give this 2nd Chapter of Paediatricians Lecture by the Chapter, my obvious answer was no. I could think...
10th Seah Cheng Siang Memorial Lecture: Going Places—A Rheumatological Odyssey
I am greatly honoured to deliver the 10th Seah Cheng Siang memorial lecture. I came into direct contact with Professor Seah in January 1965...
5th Yahya Cohen Lecture: Angiosomes and Extension of Skin Flaps—Anatomic Study and Clinical Implications
K C Tan, B K Tan
I would like to express my gratitude to the Chapter of Surgeons and the Academy of Medicine, Singapore for the honour of presenting this...
11th Chapter of Surgeons Lecture—The Art of Letting Go
G Baratham
These observations were made by a Persian mathematician some 900 years ago. His sentiments are self-evident but no less easy to accept especially for...
15th Gordon Arthur Ransome Oration: A Journey of Care—Mission Impossible?
J C Petrie
I am deeply honoured by the invitation to deliver the 15th Sir Gordon Arthur Ransome Oration. This article is available only as a PDF. Please...
The Runme Shaw Memorial Lecture 2000—Treating VIPs in Washington
L E Smith
My lecture is about people, power, illness, and the patient-physician relationship. It is the personality of the politician or official, the ego elevation conferred...
A Case of Alpha-Fetoprotein-Producing Gastric Cancer
K F Foo, C K Tan, K K Y Wong, G S Hong, B Y Ngan
A 57-year-old accountant presented to her doctors in a neighbouring country in early October 1998 with problems of easy bruising, bleeding gums, one single...
Case Report: Acute Tumour Lysis Syndrome
C T H Chuah, L C Lim
Acute tumour lysis syndrome (ATLS) is one of the most urgent of all oncological treatment-related complications. It has a broad impact on organ dysfunction,...
A Prospective Evaluation of Surgeon Performed Sonography as a Screening Test in Blunt Abdominal Trauma
E Foo, J W Su, D Menon, D Tan, S T F Chan
Over the past decade, sonography as a screening tool in the evaluation of abdominal trauma has been thoroughly investigated. This modality was first used...
Stapled Haemorrhoidectomy—The Evidence For and the Facts Against
Y H Ho
Surgeons as well as patients have recently shown much interest in stapled haemorrhoidectomy. This is a new technique, which is claimed to result in...
Double Omental Hernia—Case Report on a Very Rare Cause of Intestinal Obstruction
J Y See, A W H Ong, P T C Iau, S T F Chan
Internal hernia is defined as the protrusion of a viscus through a normal or abnormal opening within the confines of the abdominal cavity. This...
CerbB2 Status in Breast Cancer: Pathologic Issues
S C Lian, P H Tan
The cerbB2 gene, also known as Her2/neu, encodes a transmembrane cell receptor with tyrosine kinase activity and epidermal growth factor receptor homology. All normal...
Cancer Incidence in Singapore, 1998 to 1999
K S Chia, J J M Lee, J L L Wong, W Gao, H P Lee, K Shanmugaratnam
The Singapore Cancer Registry has been monitoring the trends in cancer incidence since 1968. It publishes 5-yearly incidence figures for the periods 1968-1972, 1973-1977,...
5th Tan Tock Seng Hospital Oration: Advances for Life
M L K Tay
I am honoured and privileged to have been invited to deliver the 5th Tan Tock Seng Hospital (TTSH) Oration at the Opening of your...
6th Yahya Cohen Lecture: Visual Experience During Cataract Surgery
K G Au Eong
What a patient can see during his or her surgery can be a cause of anxiety for the patient. It may cause additional stress...
Efficacy and Tolerability of Irinotecan in Patients with Advanced Colorectal Cancer in Singapore
H T See, W H Koo, P Ang, E Au, P T Ang
Colorectal cancer is the second most commonly encountered malignancy in the developed countries; in Singapore, it is the commonest cancer. With early detection, patients...
The Mastectomy Clinical Pathway: What Has It Achieved?
U Santoso, P T C Iau, J Lim, C S L Koh, Y T Pang
In an era of increasing healthcare cost and scarce resources, the tension between the cost and quality of healthcare demands not only effective but...
Agreement or Prediction: Asking and Answering the Right Question
S B Tan, S B Wee, Y B Cheung
In an article published in this journal, Chia discusses the difference between measuring association and agreement. In this paper, we extend the discussion to...
Preliminary Experience in Radionuclide Therapy of Hepatocellular Carcinoma Using Hepatic Intra-arterial Radio-conjugates
G H W Keng, F X Sundram, S W K Yu, S Somanesan, J Premaraj, C J Oon, R Kwok, M M Htoo
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. In Singapore, the age-standardised incidence rate is 18.9 per 100,000 per year. This article is available only...
Paediatric Extracranial Germ Cell Tumours: A Retrospective Review
L P N Lim, A M Tan, M Y Chan, V Rajalingam, J Lou, C L Tan
Germ cell tumours (GCTs) in children account for 2% to 3% of childhood malignancies. They arise from primordial germ cells and constitute a heterogeneous...
Emergency Laparoscopic Surgery—The Changi General Hospital Experience
K B L Lee, S K Wong
Today, laparoscopic surgery has achieved widespread acceptance among surgeons as well as the general public. Emergency laparoscopic procedures (ELPs) have been performed since the...
Surgical Management and Outcome of Carotid Body Tumours
Y C Por, D T H Lim, M K Teoh, K C Soo
The carotid body was first described by von Haller in 1743. It is often a small ovoid or irregular mass composed of compact pinkish...
Re: 188Rhenium-TDD-Lipiodol in Treatment of Inoperable Primary Hepatocellular Carcinoma—A Case Report
London Lucien Ooi
Hepatocellular carcinoma (HCC) is a common malignancy that is best treated by surgery. However, in the vast majority, surgery is not possible and alternative...
Hepatolithiasis —A Case Series
C T Heng, K H Liau, C K Ho, C Y Chan, M Wong, S P Chew
Intrahepatic biliary stone or hepatolithiasis is an uncommon entity worldwide, with a higher incidence in East Asia in comparison to the West. As yet,...
Is Healthcare Competition Healthy?
Boon Wan Khaw
There are many problems which all Health Ministers worry about. But we can generally boil them down to one common problem: "money no enough". This...
Acute Embolic Occlusion of the Superior Mesenteric Artery: A Case Report and Discussion of Management
S Pasupathy, M G Sebastian, K H Chia
Acute ischaemia of the bowel is a devastating condition. Recently published figures on mortality range from 30% to 60%. This article is available only as...
Carcinoma of the Cervix: Role of MR Imaging
S H Chiang, S T Quek
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...
Radionuclide Therapy of Hepatocellular Carcinoma
G H W Keng, F X Sundram
Hepatocellular carcinoma (HCC) is a common malignancy worldwide. It is a major cause of death from cancer in East Asia, especially China, Japan, Korea,...
Non-consensual Double Reading in the Singapore Breast Screening Project: Benefits and Limitations
B H Kwek, T N Lau, F C Ng, F Gao
Double reading of mammogram is not the standard practice in the United Kingdom National Health Service Breast Screening Programme (NHSBSP). Rather, single reading of...
Measuring Quality of Life in Chinese Cancer Patients: A New Version of the Functional Living Index for Cancer (Chinese)
Y B Cheung, G Y Ng, L C Wong, W H Koo, E H Tan, M H Tay, D Lim, D Poon, C Goh, S B Tan
Health-related quality of life (QOL) is recognised as an important aspect of patient care. In oncology studies, it may stand as the primary end-point....
Neonatology In Singapore: The Way We Were, The Way Forward
N K Ho
Over a span of 35 years of my working life, I have witnessed the growth of, and also grown together with, neonatology in Singapore....
Craniofacial Anomalies: Clinical and Molecular Perspectives
M Michael Cohen Jr
Cleidocranial dysplasia is an autosomal dominant skeletal disorder characterized by short stature, brachycephaly, delayed closure of the fontanelles and sutures, Wormian bones, midface hypoplasia,...
Autoimmune Liver Disease in Children
G Mieli-Vergani, D Vergani
Autoimmune liver disorders are inflammatory liver diseases characterised histologically by a dense mononuclear cell infiltrate, including plasma cells, in the portal tract (Fig. 1)...
HIV/AIDS in Children
C Pancharoen, U Thisyakorn
The human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) epidemic in Asia has grown from a handful of cases to a major...
Speech By Mr Lim Hng Kiang, Minister For Health and Second Minister for Finance, at the Opening Ceremony of the 36th Singapore-Malaysia Congress of Medicine on Thursday, 1 August 2002 at 1810 Hours at Raffles City Convention Centre
It gives me great pleasure to join you this evening at the 36th Singapore Malaysia Congress of Medicine and the 36th Annual Combined Surgical...
The Molecular Biology of Peritoneal Carcinomatosis from Gastrointestinal Cancer
D G Jayne
The term "peritoneal carcinomatosis" was first used by Sampson in 1931 to describe the intra-abdominal spread of ovarian carcinoma. Although ovarian cancers account for...
Colorectal Hepatic Metastases: Role of Radiofrequency Ablation
T N Lau, R H G Lo, B S Tan
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...
Neoadjuvant Chemotherapy in the Management of Colorectal Metastases: A Review of the Literature
S Y K Ong
Colorectal cancer accounts for the most number of deaths after lung cancer, both in the West as well as locally in Singapore. Liver is...
Hepatic Resection for Colorectal Metastases to the Liver: The National Cancer Centre/Singapore General Hospital Experience
C S C Teh, L L P J Ooi
Colorectal carcinoma is the fourth most common malignancy and the second leading cause of death worldwide. Although surgical resection in combination with adjuvant chemotherapy...
Computed Tomographic Appearance of Colorectal Hepatic Metastases
S H Chiang, C H Thng, C S C Teh, A G S Tan, S L Poddar, B S Wong, P K H Chow, A Y F Chung, L L P J Ooi
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
A G S Tan, C H Thng
Colorectal cancer is a common primary that metastasizes to the liver. About 20% of patients with colorectal cancer will have detectable metastases at the...
Current Concepts of Tumour Metastasis
A Barbour, D C Gotley
Tumour metastasis, or the spread of cancer cells from a primary tumour to distant sites, remains the principal cause of treatment failure and poor...
Chemoprevention of Colorectal Cancer – Experimental Approach and Clinical Applications
C L Tang
The age-old adage of "Prevention is Better than Cure" is still very relevant in today's practice of medicine. Many randomised population trials have already...
Practical Issues in Adjuvant Therapy for Rectal Cancer
J J Tjandra, P Gibbs, M W Chao
This article is available only as a PDF. Please click on "Download PDF" on top to view the full article.
Total Mesorectal Excision (TME) – Twenty Years On
A F P K Leong
In 1982, Heald et al1 at the Basingstoke District General Hospital introduced the concept of total mesorectal excision (TME) as a means of performing...
Flat and Depressed Lesions of the Colon and Rectum: Pathogenesis and Clinical Management
K Togashi, F Konishi, K Koinuma, T Ishitsuka, M Kojima, M Okada, H Nagai
It was previously thought that the vast majority of colorectal cancers were derived from polypoid adenomas. However, several investigators have noted that most colorectal...
Surgical Management of Colorectal Metastases to the Liver
P C Cheow, L L P J Ooi
Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver...
Recent Advances in the Total Management of Colorectal Cancer
Y H Ho, L L P J Ooi
Considerable improvements in the survival and outcome of colorectal carcinoma have been made in recent years. These have been the result of advances in...
Unusual Case of Bowel Infarction with Invasive Aspergillus in an Immunocompromised Patient
M H Tay, C Balram, K F Foo, I Busmanis, S Raman, K S Khoo
The role of neoadjuvant chemotherapy for locally advanced breast cancer has been established and there has been a growing interest in its role in...
Inflammatory Fibroid Polyp of the Caecum in a Patient with Neurofibromatosis
C Ng, KY Lam, TS Gupta, YH Ho
Inflammatory fibroid polyp is an uncommon nonneoplastic lesion found in the gastrointestinal tract. It is a benign, non-encapsulated submucosal lesion, composed mainly of loose...
Inaugural College of Obstetricians & Gynaecologists Lecture: Recent Developments in Obstetric Care and Maternal Fetal Medicine in Singapore
GSH Yeo
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...
Citation on Dr Andrew Chew Guan Kuan for Admission to Honorary Fellowship on 19 August 2004
YC Chee
It is indeed a great pleasure and honour to present to you Dr Andrew Chew Guan Khuan, who is already a Fellow of the...
Citation on Sir Donald Irvine – 17th Gordon Arthur Ransome Orator
LY Ho
It is my pleasure and privilege to introduce Sir Donald Irvine as the 17th Gordon Arthur Ransome Orator. This article is available only as a...
Address by Master, Academy of Medicine, Singapore at the Opening Ceremony of the 38th Singapore-Malaysia Congress of Medicine and Induction Ceremony
CH Low
It is my pleasure to welcome you to the Opening Ceremony of the 38th Singapore-Malaysia Congress of Medicine with participation of the Hong Kong...
1st College of Physicians Lecture: The Role of Internal Medicine as a Specialty in the Era of Subspecialisation
It humbles me to accept the invitation to give this lecture, the First College of Physicians Lecture, titled "The Role of Internal Medicine as...
15th Chapter of Surgeons Lecture: Surgeon of the New Millennium – Surgeon, Scientist and Scholar
SK Tan
Next year, we celebrate a hundred years of medical education in Singapore. We have come a long way since 1821 – from a small,...
Standards and Revalidation or Recertification
D Irvine
In my Gordon Arthur Ransome Oration and other papers, I have described the nature and development of patient-centred professionalism, the key features of which...
Continuing Professional Development – a Surrogate for Recertification?
GWK Tang
The Hong Kong Academy of Medicine is a statutory body set up in 1993 with the objectives of fostering the development of postgraduate medical...
Teaching and Learning of Professionalism in Medical Schools
N Sivalingam
There is now worldwide consensus that the elements of medical professionalism need to be enhanced and explicitly taught in medical schools. Medical schools in...
The Challenge of Teaching Professionalism
G Beauchamp
For the past 25 years, professionalisation, industrialisation, large-scale infusions of technology into the healthcare system and consumerism, to name a few factors, have definitely...
2004 Runme Shaw Memorial Lecture: Professionalism – A Concept in Need of Nurturing
JWD McDonald
It is a great honour to be invited to deliver the Runme Shaw Memorial Lecture. I am grateful to the Runme Shaw Foundation for...
17th Gordon Arthur Ransome Oration: Patient-centred Professionalism
When sickness strikes we all need doctors. People everywhere know that the quality of medical care can affect the outcome and possible consequences of...
The Role of Public Health and Occupational Physicians in the New Millennium
HP Lee
I want to thank the Chapter and organisers for honouring me with this kind invitation to speak to you. This millennium is only 4...
Flap Prefabrication – The Bridge Between Conventional Flaps and Tissue-engineered Flaps
BK Tan, HC Chen, TM He, IC Song
Flap prefabrication is one of the most exciting areas in Plastic Surgery because of its bridging role between conventional reconstructive surgery and tissue engineering....
Littoral Cell Angioma of the Spleen
YM Tan, KL Chuah, WK Wong
The littoral cells line the vascular channels of the red pulp of the spleen and have characteristics of endothelial and histiocytic cells. In 1991,...
The HercepTest and Routine C-erbB2 Immunohistochemistry in Breast Cancer: Any Difference?
S Selvarajan, BH Bay, MJ Chng, PH Tan
The proto-oncogene c-erbB2 (also known as HER2/neu) is located on chromosome 17q21 and encodes a 185-kD transmembrane glycoprotein. It belongs to the human epidermal...
Refining Clinical Practice: Transforming Science Research into the Art of Medicine
I am humbled by the invitation given to me by Changi General Hospital to deliver this lecture at your 5th Annual Scientific Meeting with...
14th Chapter of Surgeons Lecture: Back to Basics
Balaji Sadasivan
I am happy to be among old friends. As surgeons, we share a kindred spirit. I wish to thank the Academy for the honour...
A Case of Metastatic Squamous Cell Carcinoma of the Hypopharynx Manifesting as Acute Abdomen
ZW Wong, SS Leong, T Tan, K Mancer
T, a 23-year-old female, was previously well until November 2000 when she presented with 1-year history of sore throat associated with neck lumps for...
A Case of Maffucci's Syndrome With Pleural Effusion: Ten-year Follow-up
C Biber, P Ergun, UY Turay, Y Erdogan, SB Hizel
A 23-year-old male patient was admitted to Ataturk Chest Disease Hospital with non-productive cough, dyspnoea, chest pain and back pain. These complaints had begun...
Clinical Indications for Positron Emission Tomography (PET) Scanning
The Workgroup for the Chapter of Radiologists, Academy of Medicine
The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...
Positron Emission Tomography – A Vital Component of Molecular Imaging
ASW Goh, DCE Ng
Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...
Two Case Reports of Metastases from Colon Carcinoma to the Thyroid
D Poon, HC Toh, CS Sim
Metastases to the thyroid are not as rare as previously believed and have been shown, in autopsy series, to be more common than primary...
Trends in Cancer Incidence Among Singapore Malays: A Low-risk Population
H Wang, A Seow, HP Lee
Cancer is now one of the most common causes of death in the world. Inspection of changes in cancer incidence in ethnically or geographically...
Image-guided Radiofrequency Ablation of Liver Malignancies: Experience at Singapore General Hospital
Shoen CS Low, Richard HG Lo, Te-Neng Lau, London Lucien PJ Ooi, Chee-Keong Ho, Bien-Soo Tan, Alexander YF Chung, Wen-Hsin Koo, Pierce KH Chow
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...
3rd College of Physicians' Lecture – Translational Research: From Bench to Bedside and From Bedside to Bench; Incorporating a Clinical Research Journey in IgA Nephritis (1976 to 2006)
Keng-Thye Woo, Yeow-Kok Lau, Hui-Kim Yap, Grace SL Lee, Hui-Lin Choong, A Vathsala, Gilbert SC Chiang, Evan JC Lee, Kok-Seng Wong, Cheng-Hong Lim
In our quest to pursue knowledge regarding a patient's illness or seek a cure for the disease, as doctors we have to derive the...
16th Seah Cheng Siang Memorial Lecture – The Changing Face of Cardiology Practice, Training and Research in Singapore
Boon-Lock Chia
Professor Seah Cheng Siang was one of the most illustrious physicians of his era. During his professional career, he held the following positions: Head,...
Detection and Quantification of the Abelson Tyrosine Kinase Domains of the bcr-abl Gene Translocation in Chronic Myeloid Leukaemia Using Genomic Quantitative Real-time Polymerase Chain Reaction
Charles A Gullo, Charles TH Chuah, William YK Hwang, Gerrard KH Teoh
Chronic myeloid leukaemia (CML) is a clonal stem cell malignancy characterised by massive proliferation of mature and immature granulocytes, basophils and spleen cells, but...
The Feminist Approach in the Decision-making Process for Treatment of Women With Breast Cancer
Ewa Szumacher
The ethical theories employed in healthcare today generally assume a modern Western philosophical framework, which is applied to many issues such as abortion, euthanasia,...
3rd FY Khoo Memorial Lecture – Education, Professionalism, Outsourcing and the Future of Radiology
Adrian K Dixon
Radiology is undergoing unprecedented changes. Not only is the technology evolving rapidly, providing images of breathtaking anatomical clarity, but functional information has also become...
Cutaneous and Subcutaneous Metastases of Adenocarcinoma of the Colon and Rectum
Kok-Yang Tan, Kok-Sun Ho, Jiunn-Herng Lai, Jit-Fong Lim, Boon-Swee Ooi, Choong-Leong Tang, Kong-Weng Eu
Cutaneous metastasis from colorectal adenocarcinoma is an interesting condition not only because of its rarity, it occurs in less than 4% of patients with...
Infected Pancreatic Necrosis – An Evaluation of the Timing and Technique of Necrosectomy in a Southeast Asian Population
Victor TW Lee, Alexander YF Chung, Pierce KH Chow, Choon-Hua Thng, Albert SC Low, London-Lucien PJ Ooi, Wai-Keong Wong
The management of necrotising pancreatitis has improved significantly over the last 2 decades, with a corresponding improvement in mortality rates. This improvement is largely...
Complications Relating to Intravenous Buprenorphine Abuse: A Single Institution Case Series
Andy KS Yeo, Chung-Yip Chan, Kok-Hoong Chia
Buprenorphine, more commonly known as Subutex (Reckitt Benckiser Pharmaceuticals), has been released in Singapore since 2002. Initially marketed as an opiate substitute to help...
Postirradiation Sarcoma of the Sphenoid Bone – A Case Report
Wan-Yee Teo, Henry KK Tan, Boon-Cher Goh, Thomas C Putti
Radiation-associated tumours of the temporal and maxillary bone have been reported in patients treated with radiotherapy for nasopharyngeal carcinoma. There was no previously reported...
10th Yahya Cohen Memorial Lecture: Clinical Predictors in Obstructive Sleep Apnoea Patients with Computer-assisted Quantitative Videoendoscopic Upper Airway Analysis
PP Hsu, BYB Tan, YH Chan, HN Tay, PKS Lu, AKL Tan, RL Blair
Obstructive sleep apnoea (OSA) is a common disease, which is estimated to affect up to 2% of middle-aged women and 4% of middle-aged men.1...
New Treatments for Atopic Dermatitis – Facts, Comparisons and Uncertainties
M Bigby
Atopic dermatitis is associated with asthma and allergic rhinitis, and presents with a typical morphology and distribution. Eighty-four per cent of cases of atopic...
Phase II Trial of Gemcitabine and Cisplatin Sequentially Administered in Asian Patients With Unresectable or Metastatic Non-small Cell Lung Cancer
D Poon, KF Foo, L Chew, SS Leong, J Wee, EH Tan
Lung cancer is the most common cause of cancer-related death worldwide. It ranks first among males and third among females in the incidence of...
Implementation and Evaluation by Formal Assessments and Term End Student Feedback of a New Methodology of Clinical Teaching in Surgery in Small Group Sessions
K Veena L Karanth, MV Kumar
In clinically-oriented subjects such as surgery, specific guidelines for conducting small group teachings are lacking. Different methods are being practiced and researched in different...
Putting Together Lesions in the Brain, Retina, Kidney and Pancreas
Deidre Anne De Silva, Andrew BS Pan
A 40-year-old Malay lady presented with a 6-month history of headache. She had a past history of a left nephrectomy 6 years ago. This article...
Successful Management of an Iatrogenically-ingested Sharp Foreign Body
Gavin CW Kang, Preetha Madhukumar
A 37-year-old man with no significant medical history underwent dental treatment. An injection dental needle used in the course of root canal treatment came...
Tuberculosis Masquerading as Recurrent Metastatic Carcinoma of the Cervix
Dk Hana Naqiyah PH Baharudin, Hj Muhd Syfiq Abdullah, Chee Fui Chong, Roselina Bte Hj Yaakub, Vui Heng Chong
The incidences of certain malignancies are increasing and are major causes of mortality. Diagnosis can be difficult and delayed. This article is available only as...
Association of Epstein-Barr Virus with Nasopharyngeal Carcinoma and Current Status of Development of Cancer-derived Cell Lines
Charles Gullo, Wong Kein Low, Gerrard Teoh
Although nasopharyngeal carcinoma (NPC) has been reported in almost all parts of the world, most cases of NPC are found in South East Asia,...
Brachytherapy – One Man's Meat, A Personal Journey in Radiation Oncology
TH Khor
Dr Tan Kim Ping, Chairman for the Dr FY Khoo Memorial Lecture, Ladies and Gentlemen – It is a signal honour for me to...
Retinal and Cardiovascular Diseases: The "Common Soil" Theory
Tien Y Wong
There is increasing evidence that retinal and cardiovascular diseases share a "common soil". Risk factors for cardiovascular disease, such as hypertension, diabetes, hyperlipidaemia and...
Massive Retroperitoneal Adrenal Haemorrhage as the First Manifestation of a Lung Cancer
Saqib Ahmad, Rayid Abdulqawi, Khaled Ashawesh
A 74-year-old man was admitted with sudden onset of right upper quadrant abdominal pain radiating towards right shoulder and right thigh. Pain was aggravated...
4th FY Khoo Memorial Lecture 2008: Nasopharyngeal Cancer Workgroup – The Past, The Present and The Future
Joseph Wee
Thank you Madam Chairman. First, I would like to thank the Singapore Radiological Society and the College of Radiologists, Academy of Medicine Singapore for...
Phase II Trial of Gemcitabine in Combination with Cisplatin in Inoperable or Advanced Hepatocellular Carcinoma
Whay Kuang Chia, Simon Ong, Han Chong Toh, Siew Wan Hee, Su Pin Choo, Donald YH Poon, Miah Hiang Tay, Chee Kiat Tan, Wen Hsin Koo, Kian Fong Foo
Hepatocellular carcinoma (HCC) has a high incidence rate in Asia. In Singapore, it is the third most common cancer amongst males, and constituted 8%...
Pancreas-only Metastasis from Nasopharyngeal Carcinoma
Sing-Huang Tan, Alvin SC Wong, Thomas P Thamboo, Stephen KY Chang, Christopher JL Khor
A 51-year-old Chinese man presented with a 3 month's history of left cervical lymphadenopathy, rhinorrhoea, tinnitus and nasal congestion. On nasopharyngoscopy, a fungating mass...
3rd College of Paediatrics and Child Health Lecture – The Past, the Present and the Shape of Things to Come…
Kah Yin Loke, Jeremy BY Lin, Deurenberg-Yap Mabel
In the post-war days of the 1950s, Singapore children were faced with problems of malnutrition and infectious diseases. There was poverty, overcrowded housing and...
Induction Concurrent Chemoradiotherapy Using Paclitaxel and Carboplatin Combination Followed by Surgery in Locoregionally Advanced Non-Small Cell Lung Cancer – Asian Experience
Swee-Peng Yap, Wan-Teck Lim, Kian-Fong Foo, Siew-Wan Hee, Swan-Swan Leong, Kam-Weng Fong, Philip Eng, Anne AL Hsu, Joseph TS Wee, Thirugnanam Agasthian, Heng-Nung Koong, Eng-Huat Tan
Lung cancer is the leading cause of cancer mortality in Singapore. The age standardised incidence rate is 45 per 100,000/year. This article is available only...
Advanced Burkitt's Lymphoma Presenting With Jejunal Perforation
Jaideepraj Rao, Kwang Chear Lee, Lester Chan, Khoon Leong Chuah, Ming Terk Chiu
Burkitt's lymphoma (BL) is a high grade B-cell neoplasm under the umbrella of non-Hodgkin's lymphomas. It is predominantly seen in children but may also...
Successful Surgical Treatment of Renal Cell Carcinoma With Calvarial Metastases
Abdullah Altintas, Timucin Cil, Semir Pasa, Ilhan Kilinc, Abdurrahman Isikdogan
Renal cell cancer (RCC) accounts for 3% of all cancers. Isolated haematuria or pain is the most common form of presentation. This article is available...
Angioplasty in Critical Limb Ischaemia: One-year Limb Salvage Results
Uei Pua, Daniel ES Wong
Critical limb ischaemia (CLI) is the most severe form of peripheral vascular disease where there is inadequate blood flow to a limb to maintain...
The Toxicity and Outcomes of Continuous 5-fluorouracil/Cisplatin-based Chemotherapy Followed by Chemoradiation in Patients with Resected High-risk Gastric Cancer: Results of a Single Institute
Rottenberg Yakir, Kadouri Luna, Wygoda Marc, Sella Tamar, Rivkind Avraham, Hubert Ayala
Gastric carcinoma is the second most common cause of cancer mortality worldwide. Surgery is the only curative therapy, although 5-year survival rates remain poor...
Local Experience of Endorectal Magnetic Resonance Imaging of Prostate with Correlation to Radical Prostatectomy Specimens
Judy SP Tan, Choon Hua Thng, Puay Hoon Tan, Christopher WS Cheng, Weber KO Lau, Terence WK Tan, Juliana TS Ho, Boon Chye Ching
Prostate cancer ranks among the top 10 cancers in Singapore. The incidence of prostate cancer has risen by 5% to 118% in most Asian...
MMP-2, TIMP-2 and CD44v6 Expression in Non-small-cell Lung Carcinomas
Bulent Eren, Mehmet Sar, Buge Oz, Fazilet H Oner Dincbas
Studies have provided data that matrix metalloproteinases (MMPs) facilitate tumour invasion, the establishment of metastases. On the other hand, matrix metalloproteinase inhibitors have been...
The Role of Electrophysiology in the Diagnosis and Management of Cervical Spondylotic Myelopathy
Yew-Long Lo
Cervical spondylosis is an extremely common condition managed by both physicians and surgeons in daily clinical practice. Cervical spondylotic myelopathy (CSM), resulting from longstanding...
Demands and Challenges of Modern Medicine
Pin Lim
I am deeply honoured by the invitation to deliver the 16th Tun Dr Ismail Oration and I wish to thank the Master and Council...
Happenings in Histopathology – A Post-World War II Perspective
K Shanmugaratnam
During the past few decades, there have been many significant developments in the practice of histopathology, the specialty that is also referred to as...
Noninvasive follicular thyroid neoplasm with papillary-like nuclear features and the risk of malignancy in thyroid cytology: Data from Singapore
Bryan Lee Wei Wen, Manish Mahadeorao Bundele, Rong Tan, Ernest Fu Wei Zhong, Agnes Chew Siqi, Junice Wong Shi Hui, Caroline Siew Ching Hsia, Brenda Lim Su Ping, Rinkoo Dalan, Ming Yann Lim, Yijin Jereme Gan, Hao Li
As only 5–10% of thyroid nodules harbour malignancy, fine-needle aspiration (FNA) is important in triaging nodules requiring surgical excision from nodules that may be...
Multimodal prehabilitation before major abdominal surgery: A retrospective study
Ning Qi Pang, Stephanie Shengjie He, Joel Qi Xuan Foo, Natalie Hui Ying Koh, Tin Wei Yuen, Ming Na Liew, John Peter Ramya, Yijun Loy, Glenn Kunnath Bonney, Wai Kit Cheong, Shridhar Ganpathi Iyer, Ker-Kan Tan, Wan Chin Lim, Alfred Wei Chieh Kow
Ageing is one of the biggest public health concerns of the 21st century, presenting a challenge to the practice of medicine globally. As the...
Characteristics of unplanned hospitalisations among cancer patients in Singapore
Qingyuan Zhuang, Joanna SE Chan, Lionel KY See, Jianbang Chiang, Shariff R Suhaimi, Tallie WL Chua, Anantharaman Venkataraman
Cancer is a pervasive global problem with growing healthcare utilisation and costs.1-3 This situation is similar in Singapore where cancer incidence is on the...
The case for better hospitalisation selection in cancer patients
Darren Wan-Teck Lim, Quan-Sing Ng
Public hospital occupancy rates and resource utilisation in Singapore are perennially high. In the last 2 years of the COVID-19 pandemic, there has been...
Tumour Interstitial Fluid Pressure May Regulate Angiogenic Factors in Osteosarcoma
Saminathan S Nathan, Andrew G Huvos, Jorge E Casas-Ganem, Rui Yang, Irina Linkov, Rebecca Sowers, Gene R DiResta,, Richard Gorlick, John H Healey,
Solid tumours have states of raised interstitial fluid pressure (IFP) that cause significant changes to their physiology.1-3 We have previously shown that human osteosarcomas...
Surgical Training – The Challenge of Change
Raj M Nambiar
President of the College of Surgeons, distinguished guests, friends, ladies and gentlemen. It is a great honour and a unique privilege for me to...
Preparedness for Terrorism: Managing Nuclear, Biological and Chemical Threats
Kristi L Koenig
Preparedness for terrorism in the 21st century includes addressing the management of nuclear, biological and chemical (NBC) terrorism events. Understanding the terrorist threat and...
Outcomes of Oral Tongue Cancer: Does Age Matter?
Connie SP Yip, Tze Choong Charn, Joseph TS Wee, Terence WK Tan, Christopher Goh, Hiang Khoon Tan, Kam Weng Fong
Oral cancer (including oral cavity and oropharynx) is the eighth most common cancer worldwide with oral cavity cancer among the 3 most common malignancies...
5th College of Surgeons Lectureship: Surgery beyond Scalpels
Cheng Hock Low
The training of surgeons composed of two aspects: (1) Clinical skill and competence; (2) The 'soft' skill and 'art' of surgery. With the gradual...
The Evolution of Radiology from Paraclinical to Clinical
Hong Khim Boey
I would like to thank the Academy of Medicine and the Singapore Radiological Society for giving me the honour of delivering this year's F...
Hepatocellular Carcinoma Peritoneal Metastases: Report of Three Cases and Collective Review of the Literature
Jesslyn H Ding, Terence C Chua, Khalid Al-Mohaimeed, David L Morris
Peritoneal dissemination of hepatocellular carcinoma (HCC) is a rare presentation, with an incidence of 2% to 6% detected during autopsy or laparoscopy. Although uncommon,...
Colorectal Cancer Liver Metastases – Understanding the Differences in the Management of Synchronous and Metachronous Disease
Ek Khoon Tan, London L P J Ooi
Colorectal cancer (CRC) is one of the commonest cancers worldwide with age standardised incidence rates of 22.8 to 64.2 and 19.0 to 46.7 per...
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
Terence C Chua, Akshat Saxena, David L Morris
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent...
Coexistence of Unicentric Castleman's Disease and Locally Advanced Papillary Renal Cell Carcinoma: More Than a Coincidental Association?
Jack JJ Chan, Alwin HL Loh, Hong Gee Sim, Min Han Tan, Chee Keong Toh
Castleman's disease (CD) is an enigmatic lymphoproliferative disorder due to its rarity, uncertain aetiopathogenesis and heterogeneous clinicopathologic forms. This case report presents an unusual...
Management of Thrombotic Thrombocytopenic Purpura in Metastatic Prostate Cancer with only Endocrine Therapy
Ravindran Kanesvaran, Colin Phipps, Christopher WS Cheng, Michelle MF Chan, Daphne Khoo, Min Han Tan
Thrombotic thrombocytopenic purpura (TTP) is a systemic disorder that presents acutely with multiple organ failure. Although defined classically as a syndrome with a pentad...
Phosph-Akt1 Expression is Associated with a Favourable Prognosis in Pancreatic Cancer
Jun Liu, Sun Hong Cheng Sun, Sun Jing Sun, Chen Huang, Hong Hui Hu, Yu Biao Jin, Zheng Jun Qiu
Pancreatic cancer is the fourth leading cause of cancer related mortality worldwide with an estimated 34,290 deaths recorded in the United States in 2008....
Emergency Surgery for a Ruptured Intra-abdominal Desmoid Tumour
Ker Kan Tan, Zhiyan Yan, Kui Hin Liau
Desmoid tumours are fibrous benign tumours that are often indolent until local symptoms evolve. We highlight a rare case of a ruptured intra-abdominal desmoid...
Prospective Audit of Febrile Neutropenia Management at a Tertiary University Hospital in Singapore
Jing Jin, Yee Mei Lee, Ying Ding, Liang Piu Koh, Siew Eng Lim, Robert Lim, Paul Ananth Tambyah, Li Yang Hsu
Febrile neutropenia (FN) is considered a medical emergency and remains a major cause of morbidity and mortality in Oncology and Haematology units worldwide. A...
An Audit Study of the Sensitivity and Specificity of Ultrasound, Fine Needle Aspiration Cytology and Frozen Section in the Evaluation of Thyroid Malignancies in a Tertiary Institution
Winson JH Tan, Kaushal Sanghvi, Kui Hin Liau, Cheng Hock Low
Thyroid lesions constitute a considerable bulk of surgical practice, majority of which are thyroid nodules. A large population study revealed that clinically apparent thyroid...
3rd College of Surgeons Lecture — Bringing up Surgeons
Siew Chey Ong
I am greatly honoured to be given the privilege of delivering the 3rd College of Surgeons Lecture, especially when I have retired from surgery...
12th Yahya Cohen Memorial Lecture – The Cellular and Molecular Basis of Radiation-induced Sensori-neural Hearing Loss
Wong-Kein Low, Michelle GK Tan, Alvin WC Chua, Li Sun, De-Yun Wang,
Radiation-induced sensori-neural hearing loss (SNHL) has long been recognised as a complication of radiotherapy (RT) for head and neck tumours, if the auditory pathways...
11th Yahya Cohen Memorial Lecture – An In vivo Comparative Study of the Ability of Derived Mesenchymal Stem Cells in the Treatment of Partial Growth Arrest
James HP Hui, Li Li, Hong-Wei Ouyang, Yee-Hong Teo, Eng-Hin Lee
It has been my greatest pleasure and honour to accept this, the 11th Yahya Cohen Memorial Lectureship on the anniversary of a half century...
Complementary and Alternative Medicine among Singapore Cancer Patients
Wen Hann Chow, Pearlly Chang, Soo Chin Lee, Alvin Wong, Han-Ming Shen, Helena Marieke Verkooijen
Worldwide, the use of Complementary and Alternative Medicine (CAM) by cancer patients is highly prevalent. For cancer specialists, knowledge on CAM use in their...
rTSβ as a Novel 5-fluorouracil Resistance Marker of Colorectal Cancer: A Preliminary Study
Yu-Li Lin, Kuan-Chih Chow
Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been...
Dilemmas in Management of Brain Tumours in Pregnancy
Pei Shi Lew, Wei Ching Tan, Wei Keat Tan, Hak Koon Tan
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...
Peritoneal-based Malignancies and Their Treatment
Melissa Teo
Peritonectomy or cytoreductive surgery has been described as the treatment of choice for selected patients with evidence of peritoneal carcinomatosis (PC) from the gastrointestinal...
Immunophenotypic, Cytogenetic and Clinical Features of 113 Acute Lymphoblastic Leukaemia Patients in China
Haixia Tong, Jihong Zhang, Chunwei Lu, Zhuogang Liu, Yingchun Zheng
Acute lymphoblastic leukaemia (ALL) is a heterogeneous disease with abnormal proliferation and accumulation of immature lymphoblasts within the bone marrow (BM), peripheral blood and...
Challenges and Pitfalls in the Introduction of Pharmacogenetics for Cancer
Marie Loh, Richie Soong
Pharmacogenetics, by definition, refers to the study of genetic differences in metabolic pathways which can affect an individual's responses to drugs in terms of...
7th College of Physicians Lecture — The Changing Face of Medicine, Medicine – Past, Present and Future
K Ranga Krishnan
When we think about medicine, just like we do about other things in life in the past and the present, we usually reflect on...
15th Yahya Cohen Memorial Lecture – The Relationship between the Air-bone Gap and the Size of Superior Semicircular Canal Dehiscence
Heng Wai Yuen, Rudolf Boeddinghaus, Robert H Eikelboom, Marcus D Atlas
Superior semicircular canal dehiscence (SSCD) can result in a characteristic constellation of vestibular and auditory features, including autophony, oscillopsia, and vertigo, and characteristic eye...
5th Chao Tze Cheng Memorial Lecture—Recent Developments in Informed Consent
Hick Tin Chao
The question of informed consent is a concern of recent origin and has engaged the mind of the medical profession here for only some...
7th Tan Tock Seng Oration: Surgical Excellence at TTSH—100 Years on and onward
Yam Cheng Chee
Mr SR Nathan, our guest of honour, Mr Gan Kim Yong, Minister for Health, Madam Kay Kuok, Chairman of NHG Board, Board members, colleagues,...
8th FY Khoo Memorial Lecture 2012 —Why Radiologists Need Philosophy
Shih Chang Wang
Firstly, I wish to thank the Singapore Radiological Society and the College of Radiologists, Singapore for deeply honouring me with the invitation to give...
6th College of Surgeons Lecture The Philosophy of Balance: The Art of Healing
Keong Tatt Foo
With the rise of high tech medicine, and emphasis on the scientific aspects of medicine, there is danger that we may lose the balanced...
Lower limb nodules
Yihao Abraham Sui, Wei Lien Rita Lai, Weiting Michelle Liang, Ziying Vanessa Lim
A 45-year-old Chinese woman with no medical history or regular medications presented with painful nodules on her left shin that progressed to involve her...
A pedunculated mass of the thigh
Chern Yue Glen Ong, Rui-Ming Teo, Yonghan Ting
A 61-year-old Chinese woman presented to the general surgery clinic for a long-standing lump over her proximal medial right thigh. The painless lump was...
Managing buccal space tumours
Augustine Yui Ler Chai, Ming Yann Lim, Hao Li, Ernest Weizhong Fu, Jin Keat Siow, Yijin Jereme Gan
Dear Editor, The buccal space is an infrequently addressed fascial space of the head and neck region. Intrinsic tumours of the buccal space are...
Acute Marjolin's Ulcer: A Forgotten Entity
Leonard JM Soh, Hiang Khoon Tan
Marjolin's ulcers are malignancies that arise from areas of chronic irritation or injury that undergo malignant transformation after a period of many years. Such...
Kidney Cancer and Diabetes Mellitus: A Population-Based Case-Control Study in Taiwan
Shih Wei Lai, Kuan Fu Liao, Hsueh Chou Lai, Pang Yao Tsai, Fung Chang Sung, Pei Chun Chen
Kidney cancer accounts for 3% to 4% of all cancers. In a systematic review by Mathew and et al,2 the incidence of kidney cancer...
A 22-year-old Woman Had a Lung Mass
Chee Hwee Lee, Chien Jui Cheng, Wing Pong Chan
A 22-year-old woman had an abnormal chest X-ray (Fig. 1) in her regular health examination. She was asymptomatic and a non-smoker. Chest computed tomography...
Bilateral Polychromatic Crystalline Keratopathy as the Initial Manifestation of IgG-Lambda Multiple Myeloma
Fong Yee Foo, Christopher Khng, Li Wern Voon
Dear Editor, Multiple myeloma is a subgroup of plasma cell dyscrasias with neoplastic proliferation of plasma cells or their precursors. Crystalline keratopathy is a well-recognised...
200 years of surgery at the General Hospital, Singapore
Joshua Quan Chen Ooi, London Lucien Peng Jin Ooi
Western medicine in Singapore began with Sir Stamford Raffles' arrival on 28 January 1819 with a sub-assistant surgeon, Dr Thomas Prendergast, providing medical care...
Low-Grade Fibromyxoid Sarcoma of the Thyroid: A Case Report
Wenwu Dong, Hao Zhang
Dear Editor, Low-grade fibromyxoid sarcoma (LGFMS) is a rare form of neoplasm that usually occurs in the deep soft tissue of the lower limbs with...
2013 Runme Shaw Memorial Lecture: Clinical Applications of Stem Cells in Modern Medicine—21st Century and Beyond
Huck Hui Ng
The rapid advancement of biomedical research in the recent years was propelled by a series of groundbreaking technological inventions and breakthrough discoveries. In this...
22nd Gordon Arthur Ransome Oration: Is Medicine Still an Art?
James Best
Distinguished guests and colleagues in medicine, I am deeply honoured to have been invited to deliver this 22nd oration in honour of Sir Gordon...
Five Patients with Medullary Thyroid Carcinoma Presenting as Asymptomatic Elevation of Carcinoembryonic Antigen Level
Khai Tong Tan, Joshua ZC Tan
Early detection of malignancies is not easy. Few methods of health screening have been proven to be of value. The use of carcinoembryonic antigen...
Too Much Medicine: Time to Stop Indiscriminate Cancer Screening
Raymond CH Ng
Like most industrialised countries in the world, cancer has now become the leading cause of mortality in Singapore. Approximately 1 in 3 deaths in...
Assessment of Age in Ulcerative Colitis Patients with Ileal Pouch Creation—An Evaluation of Outcomes
Ker Kan Tan, Ragavan Manoharan, Saissan Rajendran, Praveen Ravindran, Christopher J Young
A total proctocolectomy is considered the standard of care in patients with ulcerative colitis (UC). The indications for this operation in patients with UC...
24th Seah Cheng Siang Lecture: Seeing Better, Doing Better—Evolution and Application of Gastrointestinal (GI) Endoscopy
Khean Lee Goh
Man's innate curiosity to study the internal organs of the human body dates back to the time of Hippocrates where basic speculums were invented...
Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases
Brian K Goh, Zhongkai Wang, Ye-Xin Koh, Kai-Inn Lim
Over the past few decades, the introduction of laparoscopic surgery has been the biggest game changer in abdominal surgery.1 However, although the first laparoscopic...
Laparoscopic liver resection: Global diffusion and learning curve
Epameinondas Dogeas, Samer Tohme, David A Geller
Laparoscopic liver resection (LLR) is being utilised with increasing frequency worldwide, as initial concerns about the safety and feasibility of LLR, such as the...
Prehabilitation and Its Role in Geriatric Surgery
Alfred WC Kow
The population in Singapore is ageing rapidly. According to statistics, by 2030, 1 in 2 adults in Singapore will be >65 years old. As...
New-onset cardiovascular risk factors following liver transplantation: A cohort analysis in Singapore
Xiao Ying Li, Hiang Keat Tan, Yet Hua Loh
Malnutrition is well described in liver cirrhosis. The hyperdynamic circulation and altered metabolism in cirrhosis result in a hypercatabolic state which accelerates tissue breakdown....
Outcomes of oesophageal cancer treated with neoadjuvant compared with definitive chemoradiotherapy
Caryn Wujanto, Jeremy Tey, Balamurugan Vellayappan, Jimmy So, Wei Peng Yong, Asim Shabbir, Michelle Tseng, Yu Yang Soon, Francis Ho
Oesophageal cancer is the 7th most common cancer in the world, with 572,034 new cases diagnosed in 2018, and is the 6th most common...
Congenital adhesion band causing recurrent subacute intestinal obstruction in a virgin abdomen
Jia Hao Law, Su Ann Lui, Zong Jie Koh, Ning Qi Pang, Celene Wei Qi Ng
Intestinal obstruction (IO) caused by malignancy and adhesion bands from previous surgery is common among adults. However, IO caused by congenital adhesion bands (CAB)...
Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians
Sally SJ Chan, Yiu Che Chan, Stewart R Walsh, Tze Tec Chong, Edward TC Choke, Alok Tiwari, Tjun Yip Tang
In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which...
Transcatheter Aortic Valve Implantation in Singapore: Reflecting on the First Decade
Edgar LW Tay
Transcatheter aortic valve implantation (TAVI) has markedly changed the way aortic valve stenosis is treated. It is 18 years since the first patient was...
Circulatory collapse from rupture of splenic artery aneurysm: A case study
Mervin Ye Qing Tan, Alexandra Jen Tsao-Yin Wong, Lwin Aung, Wei Ming Ng, Wei Feng Lee, Beng Leong Lim
Splenic artery aneurysms (SAAs) are uncommon and often asymptomatic. However, ruptured SAAs can be rapidly fatal. We reviewed the literature on SAAs and highlighted...
Penile preserving surgery in penile cancer management
Mon M Oo, Jeffrey J Leow, Weida Lau
Penile cancer is a condition that accounts for approximately 0.4% of cancers among Singapore males. Overall, this is an uncommon cancer with higher rates...


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Foxwoods Resort and Casino in Ledyard, CT is about a 3 hour drive from my house. Usually my husband, cousin and I make an overnight trip up there about once or twice a year. We made a trip up there this past weekend.
Foxwoods has 3 different hotel towers that are part of the main building, the Grand Pequot Tower, the Great Cedar Tower and the Fox Tower. The Fox Tower is the newest and furthest away from the main gaming / dining area but you can tell that it is the newest. There is also Two Trees Inn which, while owned by Foxwoods, it is not connected to the main building. There is a shuttle bus that will transport you back and forth.
For this stay, we were in the Great Cedar Tower. We had a very nice room but you could tell it was one of the older towers. The elevator was clean but had seen better days. And we all commented how small the flat screen TV was in the room, though I'm sure it was impressive that it had a flat screen TV at all when it was installed.
We have developed somewhat of a routine to our visits. We drive up to arrive midday, get checked into our room and then have a sit down lunch. This time we decided go to the Hard Rock Café. It was a little busy but we were seated right away. While nothing fancy, I enjoyed a burger and fries there.
After lunch, we part ways. My husband will go off to the poker room and my cousin and I will hit the slots for a while before Bingo. Yes, I like to play bingo. J Since it was a Sunday night, the admission was $15 dollars and then I usually get about $15 worth of specials (games played in addition to the regular games). The bingo session will usually last about 4 hours, with one intermission. I figure it is worth $30 to play bingo for 4 hours. I would be broke quickly if I spent 4 hours playing slots. Instead of dinner, we usually get a few snacks to munch while playing.
We have been going to play bingo at Foxwoods before it was even a full casino and it was just a bingo hall. I would guess that it has been at least 20 years. In all that time, we have NEVER won! To say we are overdue for a win there is an overstatement. But guess what? We didn't win again! Oh well.
It was about 11 pm and we left the bingo session to play a little bit of slots before calling it a night. I was in search of the "Ellen" machine (made with the theme of the Ellen DeGeneres show). My husband had looked around for it and texted me the location so that is where we headed. Thankfully, his luck had been better at poker so he called it a night while we went to play. I was down some money but Ellen was lucky and I made some back (and the machine was fun!) before we called it a night about 1 am.
The next morning, my cousin and I were up and ready for breakfast by 9. We like to go to Junior's which is in the Fox Tower. I had a pastrami omelet which was tasty and I was eyeing up cheesecake to pick up later to take home, though I never got back over there to do that. My cousin and I played some slots over in the Fox section but I wasn't having any luck so I wanted to head back to Ellen! Meanwhile, my husband slept in a bit, checked out of the room and went back to poker.
I got my Ellen machine and once again Ellen was good to me! I tried a few other machines too and decided to call it a day with about a $30 loss total. I went and got a coffee while waiting for my cousin. She was still playing and I saw a machine that I like with a kitten theme. What the heck, I'll play $20 more since I am waiting. And then I hit the bonus game and won $100! That was good enough for me so I cashed out just as my cousin was finished as well.
We texted my husband who was also wrapping up at the poker table. We had planned to leave around 1 pm so we wouldn't hit rush hour traffic on the way back. So all in all, it was a successful and pleasant trip to Foxwoods.
I would really like to make a long weekend trip there soon. There is more and more to do in the area, besides gambling. Foxwoods is going to be adding a Tangers Outlet that appears will be connected right to the main building. They already have a nice shopping and food court area that has been redone. Mystic Seaport and Aquarium are about a 15-20 minute drive from there. I also took note to a Hilton and another hotel (I can't remember the name) within a few minute drive of Foxwoods that are new if you don't want to stay right at Foxwoods. Weekend prices can be a lot which is way we usually go on a Sunday – Monday or a Thursday – Friday which are more reasonable.
Interested in checking it out for yourself? Contact me for more information.
The last morning is basically get up and get off the ship. The system for breakfast is that you have an assigned time at the restaurant you ate dinner at on the last night. I have found that I just don't enjoy that breakfast. I have done it in the past and I felt like it was rushed. The buffet is open in the morning so I have done that on my most recent cruises.
You need to be out of your stateroom at 8 am, so Sue and I got ready, gathered our belongings and headed up to the buffet. After breakfast, we sadly made our way off the ship, through customs and on to the Disney bus to take us to the airport. JetBlue is part of the on board check in program so Disney Cruise Line had already printed our boarding passes and checked our bags into the flight. All we had was our carry on bags which makes the whole process very easy.
And so another Disney cruise had come to an end. We loved it! I love being able to relax all day if you want… or keep busy all day going from activity to activity if you want.. or a combination of both. I can't wait to go again!
Day 4 was a day at sea and our last full day on the ship. We had reservations at Palo for brunch at 10:30 so we were in no rush to get up in the morning. I slept until about 8 and then went for a walk on deck 4. It was hot and sunny but I still love walking around deck 4. On one of my laps around, I saw all the princesses heading inside for the Princess Gathering. Where else can you see that when out for a walk?
We lounged around and then got ready for our brunch. Palo is an adult only restaurant on board that serves dinner each night and brunch on select days. A reservation is required and there is a $25 per person charge. This was my third time doing the brunch. The dinner is fantastic as well but the buffet is my absolute favorite.
The way the brunch works is you start out with a buffet selection for appetizers. There is a table of breads and pastries, a table of seafood, and a table with cheeses and antipasto. Then there are plated dishes that you can order for entrees. Those your waiter brings to your table. For dessert, again there is a buffet table with various desserts. Everything is included and you can have as much as you like.
This time, it was explained to us that a server would walk around the buffet with us individually. You would tell him what you would like and he would place it on a plate for you. Previously, it was a traditional serve yourself type of buffet. I have to say I wasn't crazy about the new system. I am not sure the reasoning.. perhaps for hygiene or presentation? I will say that the servers were very pleasant and actually made some recommendations of items to try that I would not have selected on my own. But overall I prefer to serve myself. However, it wouldn't stop me from going to the brunch again on another cruise.
The food at the brunch is outstanding! I really can't think of anything that I didn't like. I really enjoy different breads and cheeses and I love trying new ones there. I had an open faced frittata for my entrée which was great. All of the desserts were quite yummy as well.
After we rolled ourselves out of the buffet, we did some shopping and then went back to the room to change. Because it was a sea day, we found the adult pool and lounge area to be pretty full by the time we got there. So we went down to deck 4 where there are some padded lounge chairs and found a nice quiet spot for some reading and napping.
Later in the afternoon, we went to Disney Tunes Trivia. There were 10 songs played by a pianist that we needed to name and then 2 trivia questions about each song as well. This was a family activity so the songs were pretty easy but a few of the trivia questions were a little tricky. We ended up with 28 points out of 30 but two groups at 29 points so we didn't win anything.
The show for that evening was "Believe." Again, we had both seen in on the last cruise but it is a nice show and I enjoyed it. We then had planned to go into the adult area for a cocktail and to listen to some Broadway tunes played by the same pianist from the trivia game. When we arrived, there was just one couple there. We got our drinks and were settling in for some nice music when a loud family group arrived. They had no interest in the music and decided to set up camp at several tables to drink and bring food down from the buffet. Apparently the adult area isn't 'adult only' until after 9 pm. We tried to ignore them but it wasn't easy and put a damper on our time there.
We headed from there to our last dinner in the main dining room. We again had some fun with Victor. He had been telling us on previous nights that we should try escargot. This was the night it was on the menu. We decided to order one to share, in case we didn't like it. Victor gave a suggestion on how to eat it and I really enjoyed it. Though maybe anything would be good smothered in butter and garlic. When we got to dessert, he said he wanted to surprise us. He came out with 4 desserts so we could try different ones. We left there stuffed!
There was a premiere of the movie "Strange Magic" that night at midnight. We had considered going but it was only 10 pm by the time we finished dinner. We decided we just wanted to get in comfy clothes and relax so we went back to the room and did just that. The in room televisions have Disney movies "on demand." We had started watching "Frozen" so we went back to finish watching the rest before calling it a night.


That's the money quote from NYC Schools Chancellor Klein on the progress reports. Everything they city has done is perfect, neither he nor Mayor Bloomberg has ever made a mistake, and Mr. Klein plans to close more schools only to improve the neighborhoods. It's exactly like when Mayor Giuliani closed all those strip joints in Times Square, except he's getting rid of a different undesirable element--public schools.
Public schools divert money from the pockets of people who really need it, and this administration has embarked on the very serious business of putting more and more of it back into private hands. Why shouldn't people who run schools make a tidy little profit? In 2009, with charter schools, you don't even need your own building to do that. All over the city, you can just edge out those nasty public schools.
With any luck, Mayor-for Life Bloomberg will do away with them during his tenure. As there's nothing wrong with anything, he'll doubtless live forever, unlike those peasants the majority of whose kids fail to win the lottery anyway. And frankly, when the scourge of public schools are finally gone, the city will be "accountable" for nothing whatsoever. Schools? We don't run the schools. Go complain to Charters R Us.


Lately you might have noticed vibrant prints and swimwear disappearing from the high streets to make way for knitwear and coats. It's almost like we weren't experiencing a heatwave only 2 weeks ago. But with the shift into a new season comes new trends and colours, so we have rounded up our favourites that can work with all formal looks.
We know, this one surprised us too. It's been around 10 years since we saw neon on the high and we're glad it's not just gym wear and leg warmers this time. But neon yellow trainers and cars aren't everyone's taste so for events and occasions we suggest trying out a tie in yellow or orange along with some matching cufflinks.
These shades are typical of Autumn, muted, natural and easy to style. Rust colours can add casual warmth to an outfit in the form of a simple sweater layered over a shirt whereas a more tailored and refined waistcoat will stand out at weddings and dinners.


Animal Kingdom's 15th anniversary will surely be celebrated in many ways but recently I got to take part in a fun one for pin trading fiends like myself – the D23 Pin Trading Day at Walt Disney Imagineering! Held on the Glendale campus of WDI, once again D23 members and their guests were able to flood the campus (and again no pictures were allowed). The occasion? The celebration of the 15th anniversary of the Animal Kingdom park in Orlando, FL. To commemorate the event, they had displays of the original artwork used to design the park as well as construction photos of it being built. I was fascinated with the detail of the Tree of Life and every time I see new photos and new pictures, I find new animals I hadn't seen before. They had a maquette of the ride vehicles for Expedition Everest on display as well as trinkets and doo dads from opening day 15 years ago. One of the coolest things they did was have the original Imagineers who have worked on Animal Kingdom come and share a little about their work on the park and then sign free prints that were gifts to all attendees.
One of the Recycling Bin pins available at this WDI release party.
But for us pin traders, the action was inside of Mickey's of Glendale, the company store located on the WDI campus. Today was pin release day and as you can imagine they had a wide variety of very rare and very cool stuff for purchase. They had a wonderful framed set of the second wave of Jessica DCA pins for $300. You might think $300 for nine pins? But considering that they were Artist Proof versions of the pins framed beautifully, it was a bargain. Too bad they only had two of those and they were gone faster than you can imagine. Still, I got there early enough to get a good place in line and I was able to get all the pins I had wanted and more. For release that day was not only the 15th anniversary pin for Animal Kingdom (LE250), but also the newest Disneyland Recycling Bin Pin series and the latest of the ever-popular Sorcerer's Hat Mystery Pin series. They also had new Test Track logo pins (not my personal cup of tea) and a surprise D23 Event pin – quite the beautiful pin might I add and limited to one per person.
From the 60th anniversary celebration of Imagineering were these terrific and beautiful pins.
But in addition to these great release pins, they also had some pins available from previous releases I hadn't seen. Celebrating the 60th anniversary of Imagineering, they had "land" pins featuring the different areas of Disneyland park. Really beautiful and simply done in a 50's retro style, these pins simply feature an original attraction from the time with the name of the land on it. I had considered getting the whole set, but opted instead to only get the ones where I mainly worked – Frontierland and Adventureland. I had already spent WAY more than I had anticipated. If you are a fan of Disney, Disney Imagineering, or pins, you need to come to one of these events. And if you are a fan of all three, then why didn't I see you down there? We made friends, met new pin folks, got to trade pins, interact with the Imagineers, and they even gave away free prizes. Can you get much better than that?
For more information about these pin events, read my previous blog post on the New Fantasyland Pin Release at MOG here!


Are You Planning Strategically or Just Putting Out Fires?
As I have mentioned recently, I am in a process of refinement – of doing fewer things more effectively.
Inherent in this is the idea of honing one's skills. The goal is to improve the return on investment of your resources. That so many people I speak to tell me that they can't possibly fit one more thing into their life. They can't do anything else. What they are left with is the hard choices of choosing what to do, and what not to do. And learning how to make better use of their resources, and hone their skills.
The above image is a scene from The Last Samurai featuring the ritual of a tea ceremony. It's an image that I try to keep in my mind often. The character here has devoted his life to this ritual, to perfecting the craft of tea. That this person becomes better and better, understanding the subtle nuances that those in line at Starbucks will never know. That, when I do this in my career, I will likely find value and serendipity in places I was too busy rushing past to truly appreciate.
And yet, in many work environments, I see the opposite of this process. I don't see strategic planning, careful consideration, and a constant focus on specific goals. I see people running around, "putting out fires," as they say. In other words: they deal with the squeaky wheel, the person or project that is suddenly under deadline. In the financial world, we bemoan this as focusing only on quarterly revenue numbers, sometimes at the expense of long-term growth. We can't see the forest for the trees.
How do you spend the first working hour of your day?
Getting bogged down in the now.
Instead of envisioning what can be?
Putting out fires for others.
Instead of building a foundation for your own success.
Instead of building accomplishments over the course of years.
When Steve Jobs passed away, I heard so many people react by challenging others to truly create something original, something worthy of a legacy. I wonder, how many of those people have changed how they live already? How many have set out on a new path, one that pushes away from the status quo, from the well-tread path, to cover new ground, to create something that has never been, something they would be proud to be their own legacy?
How will you hone your vision; hone your skills; hone your craft this year? Will you quickly get caught up in the sludge of email, of the metaphorical laundry of our everyday lives – the tasks that pile up every week, but doesn't build anything of value over time.
If you need a helping hand in any of this, please feel free to connect with me.


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JustJag as dealt with many ebay sellers turning a hobby into a business. From upcycling funiture to creating and marketing online courses. A website is no longer a luxury - its a must.
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Benefit from the Venetian heritage. This book is for cooks and adventurers and for anyone who really loves Venice. We will share forgotten stories of Levantine gardens and their thousand-year-old recipes.
Grandmother Lina has been a cooking instructor for all of her life. She celebrated her 95th birthday in December 2017, and we will share not only her cooking secrets but her private insights of Venice and stories of a lifetime. A point for you to start discovering the other half of Venice, the one not open to the public.
In 2018, we will publish Lina's carefully collected knowledge as book and e-books and will launch an e-course series to share with delicious & easy recipes for food, aromatherapy, perfumes and natural remedies.
In the 1950s and 1960s, Lina taught Venetian historical recipes and food heritage to the chefs of the grandi alberghi in Venice. In her own restaurants, Lina cooked for politicians, ambassadors and two popes, John XXIII and John Paul I.
Growing up on the fringes of the northern Lagoon facing the islands of Sant'Erasmo and Le Vignole, she had her own farm-house before returning to the family home in Venice. Lina inherited the library of a Venetian Monastery and has close friends in other convents, such as on the island San Lazzaro degli Armeni and at San Francesco della Vigna.
In Venice, the old world has survived like in no other place on Earth, and here's how we can benefit from this heritage as well. We found there's still room to write on Venice, about her secret, private part. We write about gardens with a story and their recipes. While walking past, you probably wouldn't even guess their existence if it weren't for the odd wisteria twig giving away their existence. For centuries, they have been private jewels dedicated to growing the ingredients used by a forgotten style of preparing ancient recipes, combining food, beauty and natural remedies all in one. This is our neighborhood, one of the oldest grounds settled in town.
Keep in touch and get notified when we publish the book ! As a little gift, we are sharing her favorite recipe and ten culinary tips. Click below to download your gift and the book preview.