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ABSTRACT: Subdural haematomata (SDH) are usually traumatic in aetiology. Non-traumatic instances of SDH are uncommon, and can rarely be due to metastases involving the dura. Computed tomography or magnetic resonance imaging can be misleading, as the underlying aetiology may be masked by the SDH, or the appearance can simulate meningiomas. A high index of suspicion for SDH is thus required. Under such circumstances, when no overt cause is identified, dural tissue should be sent for histological analysis and blood clot for cytology, even if the appearances are grossly normal at surgery. We present a rare case of a 42-year-old woman who was previously well, but presented with progressive weakness due to acute spontaneous SDH. She required repeated surgical evacuations for SDH and for subsequent recurrent extradural haematomata. After extensive investigations, the cause was identified to be secondary dural metastases from a primary lung carcinoma.
Singapore medical journal 04/2011; 52(4):e66-9. · 0.73 Impact Factor
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B C M Koh,
L L Chong,
L G Goh,
P Iau,
P Kuperan,
L H Lee, L C Lim,
H J Ng,
A Sia,
H H Tan,
L K Tan,
K H Tay,
L T D Teo,
W C Ting,
T T Yong
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ABSTRACT: The Health Sciences Authority (HSA) and the Ministry of Health (MOH) publish clinical practice guidelines on Clinical Blood Transfusion to provide doctors and patients in Singapore with evidence-based guidance for blood transfusion. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the HSA-MOH clinical practice guidelines on Clinical Blood Transfusion, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=25700). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Singapore medical journal 03/2011; 52(3):209-18; quiz 219. · 0.73 Impact Factor
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S-Y Tan,
A-S Ooi,
M-K Ang,
M Koh,
J-C Wong,
K Dykema,
J Ngeow,
S Loong,
K Gatter,
L Tan,
L-C Lim,
K Furge,
M Tao, S-T Lim,
F Loong,
P L Cheah,
B-T Teh
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 01/2011; 25(3):555-7. · 8.30 Impact Factor
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D Tan,
Z Lao,
Y Loh,
H J Ng,
C Chuah,
G C Wong,
M Koh,
Y C Linn, L C Lim,
S L Tien,
L H Lee,
Y T Goh,
W Hwang
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ABSTRACT: The importance of achieving a very good partial response or better (≥VGPR) after induction treatment of myeloma has traditionally only been discussed in the context of high-dose therapy with auto-SCT (HDT/auto-SCT). Of late, the advent of novel agents for induction treatment has resulted in improved CR and VGPR rates, which are comparable with those observed with HDT/auto-SCT. We show that in an unselected group of 179 myeloma patients with diverse baseline characteristics, and treated with different modern induction regimens within a single institution, the attainment of ≥VGPR with or without HDT/auto-ASCT represents a major surrogate marker of better clinical outcomes. On the basis of a 1-year landmark survival analysis, patients achieving ≥VGPR enjoy a significantly longer PFS, which translated to a longer OS. Superseding the adverse effects of advanced age, high International Staging System (ISS) stage, adverse cytogenetics and independent of the transplant status, the attainment of ≥VGPR emerged as the single most significant predictor of long-term survival on multivariate analysis.
Bone marrow transplantation 02/2010; 45(11):1625-30. · 3.00 Impact Factor
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Haemophilia 12/2009; 16(3):551-3. · 2.60 Impact Factor
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Thrombosis Research 10/2009; 125(5):471-2. · 2.44 Impact Factor
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ABSTRACT: Data assessing the role of positron emission tomography (PET)/computed tomography (CT) imaging in lymphoma staging is still being accumulated and current staging is based primarily on CT. This study aims to compare the value of PET/CT over conventional CT and bone marrow biopsy (BMB) in the initial evaluation of patients with lymphoma.
Data on 122 patients with PET/CT scans as part of their initial staging were prospectively collected and reviewed. All patients had complete staging, including BMB.
Among the 122 patients, 101 had non-Hodgkin's lymphoma (NHL) and 21 had Hodgkin's lymphoma (HL). Compared with conventional CT, PET/CT upstaged 21 (17%) cases [B-cell non-Hodgkin's lymphoma (B-NHL), 12; T-cell non-Hodgkin's lymphoma (T-NHL), 3; HL, 6]. Of significance, in 13 patients with 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG)-avid splenic lesions, four had normal CT findings. A maximum FDG uptake of >10 standardized uptake value (SUV) seems to significantly correlate with an aggressive B-cell lineage (odds ratio 2.47, 95% confidence interval 2.23-2.70). Overall, PET scan was concordant with BMB results in 108 (89%) and discordant in 14 (11%) cases. In HL, our data show that PET scan and marrow results agreed in 19 of the cases (90%), being concordantly negative in 18 cases and concordantly positive in one, giving a negative predictive value (NPV) of 100%, sensitivity of 100% and specificity of 90%. Of note, all 13 with early-stage HL had negative PET/CT scan and BMB. In NHL, all 17 cases of T-NHL had concordant PET and BMB results. In patients with aggressive B-NHL, BMB and PET/CT agreed in 58 patients (92%) and disagreed in five (8%), while the corresponding rates in indolent B-cell lymphoma were 14 (67%) and seven patients (33%), respectively. All seven were falsely negative.
PET/CT upstages 17% of cases and detects occult splenic involvement. This may have potential therapeutic and prognostic implications. SUV >10 may predict for an aggressive histology. Except for indolent B-NHL, our data show that PET scans have a good overall NPV in excluding lymphomatous bone marrow involvement. This is particularly true of early-stage HL, suggesting that BMB may be safely omitted in this group.
Annals of Oncology 06/2009; 20(9):1543-7. · 6.43 Impact Factor
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Annals of the Academy of Medicine, Singapore 10/2004; 33(5 Suppl):S82-3. · 1.25 Impact Factor
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ABSTRACT: Granulocytic sarcoma is a rare extramedullary malignant mass composed of primitive cells of the granulocytic lineage. It can arise from any part of the body and is frequently associated with haematological diseases, commonly acute myeloid leukaemia. Rarely, it has been found in conjunction with myelodysplastic syndrome. We report a case of cutaneous granulocytic sarcoma in a 73-year-old lady. The patient presented with a two-month history of multiple skin nodules which were confirmed by skin biopsy to be granulocytic sarcoma. Bone marrow examination was consistent with myelodysplastic syndrome. Localised radiotherapy to the skin lesions were given. She died from septicaemia six months after presentation. The management of this condition presents a diagnostic and therapeutic dilemma for both the pathologist and physician. In cases which are poorly differentiated as in this case, histological diagnosis is particularly difficult. Its definitive diagnosis would then require the additional use of a broad panel of immunohistochemical and cytochemical stains.
Singapore medical journal 11/2002; 43(10):527-9. · 0.73 Impact Factor
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ABSTRACT: Chronic hepatitis B infection poses a problem in patients with malignancies undergoing chemotherapy. Not uncommonly, hepatitis B virus (HBV) reactivates during or soon after chemotherapy. We report a case of a woman with acute prolymphocytic leukemia who received chemotherapy containing fludarabine and cyclophosphamide, followed by the CD 20 monoclonal antibody, rituximab. She developed fatal reactivation of hepatitis B with fulminant liver failure 3 months after completing treatment. Listeria monocytogenes was concomitantly isolated. This case indicates the importance of identifying all hepatitis B carriers and the need to closely monitor and detect reactivation early. Newer chemotherapeutic agents with potentially long-lasting effects on T cells, such as purine analogues, require extended vigilance for reactivation of HBV as well as opportunistic infections. Rituximab is increasingly used alone or in combination with other chemotherapy agents. Its possible contributory role in hepatitis B reactivation needs to be defined.
Annals of Hematology 10/2001; 80(9):549-52. · 2.62 Impact Factor
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ABSTRACT: Acute tumour lysis syndrome (ATLS) is a potentially lethal but preventable complication of oncological treatment.
We report a case of a patient with Burkitt's leukaemia who developed ATLS after treatment with chemotherapy.
Standard preventive measures using aggressive hydration, urine alkalinisation and uricosuric agents were instituted before chemotherapy.
However in spite of adequate measures, the patient succumbed to the sequelae of ATLS.
It is therefore important to identify patients who are at a high risk of developing ATLS so that additional measures can be taken to prevent it from occurring.
Annals of the Academy of Medicine, Singapore 02/2001; 30(1):55-7. · 1.25 Impact Factor
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ABSTRACT: 30 adult patients with acute promyelocytic leukemia (APL) were seen at our institution overthe past 7 years. Their white cell count at presentation ranged from 400/microl to 54,900/microl. Cytogenetic studies were successful in 28 patients, of which 26(93%) were positive for t(15;17). Molecular analysis by reverse-transcription polymerase chain reaction demonstrated the PML-RARalpha fusion transcript in all 30 patients. The majority of patients had breakpoints at the 3' end with bcr1 products predominating. Complete remission rate of 92% was achieved using all-trans retinoic acid and anthracycline as induction chemotherapy in 26 patients. Of these, retinoic acid syndrome was observed in 4 cases, with 1 fatality. In conclusion, APL is a distinct entity with a highly specific molecular marker - t(15;17) translocation - that can be successfully induced into remission with all-trans retinoic acid and anthracycline in most patients.
Medical Oncology 12/2000; 17(4):301-6. · 2.14 Impact Factor
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ABSTRACT: A patient with advanced and chemotherapy-refractory nodal marginal zone B-cell lymphoma was given a course of chimeric CD 20 monoclonal antibody Rituximab. Partial response was observed without any major toxicities. Retreatment with Rituximab for disease progression six months after the first course led to partial remission. Adjuvant radiotherapy was given for the residual disease and, currently, patient's disease remains stable eight months after the second course of Rituximab. This case demonstrates the therapeutic efficacy and feasibility of retreatment with Rituximab for relapsed or refractory low grade lymphoma.
Medical Oncology 09/2000; 17(3):225-8. · 2.14 Impact Factor
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ABSTRACT: The Philadelphia chromosome is one of the commonest chromosomal aberration in adult acute lymphoblastic leukaemia (ALL) patients. We present the results of a 3-year prospective study to look at the clinico-haematologic, immunophenotypic, cytogenetic and molecular profile of 13 adult patients with Philadelphia (Ph) positive ALL out of 35 newly diagnosed ALL seen at our institution over the past 3 years.
Thirty-five adult ALL patients seen between 1996 and 1998 comprised the study group. Marrow samples were obtained for immunophenotyping and karyotypic analysis at diagnosis. Samples were also obtained simultaneously for molecular testing for Ph chromosome.
Thirteen patients were found to be Ph positive by molecular analysis while cytogenetic studies identified the chromosomal abnormality in 9 of these patients. The median age of our Ph positive patients was similar to those without Ph chromosome. Pre-B phenotype appears to be common in this group of patients. In concordance with other studies, Ph positive ALL was associated with a poor prognosis in our patients.
Identification of Ph chromosome is important in the management of patients with ALL as it is an important prognostic marker.
Annals of the Academy of Medicine, Singapore 04/2000; 29(2):159-63. · 1.25 Impact Factor
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ABSTRACT: The Philadelphia chromosome is present in a heterogeneous group of leukemias. It is most commonly associated with chronic myelogenous leukemia (CML) and B-lineage acute lymphoblastic leukemia (ALL) being found in more than 95% and 15-25% of cases respectively. We undertook a study to determine the morphologic, phenotypic and molecular diversity of Philadelphia positive de novo acute leukemia patients seen at our institution over the past 3 1/2 years. Twenty-one patients with de novo acute leukemia were found to have the Philadelphia chromosome by cytogenetic studies. They consisted of 3 patients with acute myelogenous leukemia (AML), 1 biphenotypic leukemia and 17 ALL patients. Of the patients with ALL, 16 were of B-lineage while 1 had a T-cell phenotype. Ten patients expressed the p210 BCR-ABL transcript alone and 10 expressed only the p190 BCR-ABL transcript. One patient had co-expression of p190 and p210 b3a2 BCR-ABL transcripts. Thus the Philadelphia chromosome can be found in a diverse cohort of morphologic and immunologic subtypes of de novo acute leukemia reflecting the heterogeneity of lineage involvement in this disease.
International Journal of Molecular Medicine 01/2000; 4(6):665-7. · 1.98 Impact Factor
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L C Lim
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ABSTRACT: Acquired platelet dysfunction with eosinophilia is a rare, benign self-limiting disorder characterised by platelet dysfunction and an association with parasitic infections. A 20-year-old national serviceman who presented with easy bruising and spontaneous epistaxis is reported. Investigations revealed eosinophilia and an abnormal platelet function test similar to that seen in patients with Glanzmann's thrombasthenia infections. He also had evidence of hookworm infestation. Following a course of mebendazole, his symptoms and platelet dysfunction resolved. Hence, this disorder of acquired platelet dysfunction with eosinophilia should be considered in patients with bleeding disorders secondary to platelet dysfunction.
Singapore medical journal 11/1999; 40(10):652-3. · 0.73 Impact Factor
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ABSTRACT: The referral pattern of child psychiatry was reviewed over a period of 3 years. The setting was a local general hospital with in-patient and out-patient adult psychiatric services. The cases studied were from out-patient based services rendered for children.
To draw a comparison between trends of referral from a study conducted locally in 1984 in a child guidance clinic.
A questionnaire was used to collect demographic information for children below 16 years. Medical records of patients seen between January 1992 and December 1994 were analysed.
In our study, parental referrals topped the list of source of referrals compared to referrals from school health service in the study conducted in 1984. The conditions commonly seen remained the same, namely mental retardation, neurosis and adjustment reaction.
Children were referred according to parent tolerance and acceptance of psychiatric help as well as behaviour.
Singapore medical journal 10/1999; 40(9):584-6. · 0.73 Impact Factor
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ABSTRACT: The study examined the demographic characteristic, pattern of psychiatric morbidity in offenders committed by Singapore courts and the effects of psychiatric recommendations on the disposal of these offenders.
A retrospective case-note study was done on all offenders committed by the courts from January 1987 to December 1988 to Woodbridge Hospital. A 23-item questionnaire was used to collect data from the offenders.
There were 187 offenders in the study, 165 males and 22 females. The typical offender was Chinese, male, unemployed and suffered from schizophrenia. 63.1% of the offenders required treatment after commitment. 13.9% had no psychiatric disorder. At the end of commitment, charges were dropped in 25% of cases. Theft was the most common offense and this was followed by sexual offences (molestation, outrage of modesty, exhibitionism). Offenders with schizophrenia were more likely than the others to have committed violent offences.
A large proportion of offenders were unwell at the time of the offence, the majority were suffering from schizophrenia. 13.9% had no psychiatric illness and charges were dropped in 25% indicating that the legal process could be further improved by providing additional psychiatric input to the courts so that offenders who exhibit abnormal or deviant behaviour may be appropriately dealt with.
Singapore medical journal 08/1999; 40(7):447-50. · 0.73 Impact Factor
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Journal of Clinical Oncology 07/1999; 17(6):1962-3. · 18.37 Impact Factor
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ABSTRACT: We have identified novel BCR-ABL mRNA fusions by RT-PCR in two patients with Philadelphia (Ph) chromosome positive leukaemia. Sequencing revealed in-frame fusions consisting of part of BCR exon e8 spliced to ABL exon a2 in one patient and part of BCR exon e13 spliced to ABL exon a2 in the other. The breaks within BCR exons e8 and e13 did not conform to consensus splice sites, suggesting that the aberrant fusion mRNAs may have arisen as a result of translocation breakpoints at these sites. This was confirmed by genomic DNA bubble PCR for the second patient. These data show that BCR-ABL translocation breakpoints can occasionally occur within coding exons.
British Journal of Haematology 06/1999; 105(2):434-6. · 4.94 Impact Factor
