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PubMed2006

Long-term results of liver transplant in patients with chronic viral hepatitis-related liver disease in Singapore.

INTRODUCTION: Liver disease from chronic hepatitis B (CHB) and C (CHC) constitutes 57 percent of adult liver transplant in Singapore. Their long-term results post-transplant may be affected by recurrence of the viral illness. This study aims to evaluate the long-term results and survival in patients transplanted for CHB- and CHC-related liver disease. METHODS: Patients transplanted for CHB- and CHC-related disease from 1990 until March 2004, which included decompensated cirrhosis and hepatocellular carcinoma (HCC), were reviewed and analysed. RESULTS: 25 patients were transplanted for CHB-related liver disease, with mean follow-up of 153 +/- 25 weeks. Two- and four-year survival rates were 75 percent and 69 percent, respectively. Hepatitis B recurrence from YMDD mutants occurred in five patients, and four were treated successfully with adefovir dipivoxil, with resolution in transaminases and/or improvement in histology. One patient became non-compliant with follow-up and medications, and died 173 weeks post-transplant from reactivation of the wild-type hepatitis B virus. Nine patients were transplanted for CHC-related liver disease, with mean follow-up of 188 +/- 40 weeks, and two- and four-year survival rates of 89 percent and 76 percent, respectively. Two patients developed hepatitis C recurrence and were treated with interferon and ribavarin. One responded with sustained response but the other remained viraemic and died of HCC recurrence two years post-transplant. CONCLUSION: Long-term results from CHB- and CHC-related liver diseases were satisfactory and comparable to major transplant centres in the USA and Europe. Recurrence of viral hepatitis post-transplant is controllable with current antiviral therapy.

Adult↗
PubMed2006

Radiographic features of SARS in paediatric patients: a review of cases in Singapore.

INTRODUCTION: Severe acute respiratory syndrome (SARS) is a newly emerged atypical pneumonia caused by the SARS-associated coronavirus (SARS-CoV). Chest radiographic appearances have been reported as non-specific, ranging from normal to peribronchial thickening and ill-defined airspace shadowing. This study is a retrospective review of chest radiographic findings in children with suspected and probable SARS during the 2003 outbreak in Singapore. MATERIALS AND METHODS: We focused on children admitted to the SARS treatment ward from March 2003 to May 2003. Chest radiographs of children admitted with suspected or probable SARS as well as other febrile illness during this period were retrospectively and independently reviewed by 3 radiologists. The radiographs were randomised and anonymised before interpretation. Subsequently, we identified the radiographs of patients who were categorised as suspected or probable SARS. We present our findings in these patients' radiographs. RESULTS: A total of 67 patients' serial chest radiographs were interpreted. Of these, we subsequently selected those patients with suspected or probable SARS for analysis. The radiographic abnormalities in suspected or probable SARS patients consisted of patchy ground glass opacities or patchy airspace consolidation. The abnormalities had a predominantly lower zone distribution on chest radiographs, followed by mid-zone involvement. There was a slight preponderance of peripheral zone involvement. There was equal distribution of abnormalities in both lungs. All the children with radiographic abnormalities made uneventful recoveries and had normal radiographs on follow-up review. CONCLUSIONS: In children, SARS appears to have a relatively mild and nonspecific pattern of respiratory illness. The radiographic features in children with suspected or probable SARS in our study were comparable to other clusters of paediatric patients during initial presentation. It is difficult to distinguish SARS in children from other viral pneumonias on radiographic features alone. Positive travel history to endemic regions or positive contact history, and laboratory findings of lymphopaenia, leukopaenia and thrombocytopaenia are important clues.

Child↗
PubMed1991

Hearing loss and hearing aids: the Singapore School for the Deaf experience.

This is a retrospective study of the population of 180 students in the Singapore School for the Deaf between September 1989 to June 1990. It was found that the average age at which the hearing loss was diagnosed was four years. Rubella accounted for 13 cases (7.2%), hereditary factors for nine cases (5.0%), ototoxicity for two cases (1.1%), trauma for two cases (1.1%) and the other 154 cases (85.6%) were of unknown causes. The average hearing loss at 500 Hz, 1 and 2 kHz is 98 dBHL. The students use either the body-worn type or the behind-the-ear type of hearing aids for amplification. There was little motivation to use the aids because some of them were non or malfunctioning, thereby giving little benefit or they were improperly adjusted for the child, resulting in uncomfortably loud amplification. Also, poorly fitting earmoulds give rise to feedback problems. Although early detection of hearing loss is important, it would be of little value if there is no provision of a good intervention programme with ongoing support.

Adolescent↗
PubMed1990

Norplant contraceptive implants--a comparison of capsules versus rods in Singapore.

The NORPLANT system is one of the most modern long acting steroidal fertility regulatory delivery systems to be introduced. It consists of six silicone capsules. The NORPLANT-2 rod system on the other hand consists of only 2 rods. The comparative study undertaken suggests that the NORPLANT-2 rod system is highly effective, safe and acceptable as the NORPLANT six capsule system in Singapore. It would thus appear that the NORPLANT-2 rod system as compared to the NORPLANT six capsule system has a great potential for acceptability in terms of ease of insertion and removal.

Adult↗
PubMed1990

Screening for colorectal cancer in Singapore.

The incidence of colorectal cancer in Singapore has risen relentlessly since 1955. Today, the large bowel is the most frequent gastrointestinal cancer site among both men and women. Survival with this cancer has shown little improvement during this period. The prospects for further reduction in mortality through more radical surgery, adjuvant radiotherapy, chemo- or immunotherapy remain limited. Theoretically, detection of colorectal cancer at an earlier stage or detection of its precursors will reduce mortality. Screening for colorectal cancer is advocated to achieve this end. Success with screening programmes will depend on the diffusion of current knowledge about this disease to both health professionals and the general public.

Colonoscopy↗
PubMed1990

Idiopathic bronchiolitis obliterans with organizing pneumonia in Singapore--first case report.

Idiopathic bronchiolitis obliterans organizing pneumonia (BOOP) has become accepted as a distinct disease entity. We report a patient who presented with the classical clinical, radiological and pathologic features of this uncommon condition. To our knowledge, this is first case to be reported in Singapore. This case also illustrates the difficulty of making a definitive diagnosis and emphasizes its therapeutic importance.

Aged↗
PubMed1990

Allogeneic bone marrow transplantation for acute non-lymphoblastic leukaemia--the Singapore experience.

Eleven patients with acute non-lymphoblastic leukaemia (ANNL) underwent allogeneic bone marrow transplant (BMT) from the period, September 1985 to June 1989 in the Singapore General Hospital. Five of the six patients (83%) transplanted in the first remission are presently alive; three greater than 2.5 years after the transplant. Two of these three patients are enjoying disease free survival; the other had chronic graft versus host disease but well controlled with treatment. One of the six patients relapsed from his disease at Day 252 post-transplanted and died 8 months later. Four patients who were transplanted in the first untreated relapse and one in second remission have died; three from early post-transplant complications and two from relapse. The results of allogenic BMT in patients with ANNL in first remission in this study appear encouraging and are superior to conventional chemotherapy. Allogeneic BMT should be considered as the treatment of choice in selected groups of individuals with ANNL. (Abbrev.: BMT = Bone marrow transplant; ANNL = Acute non-lymphoblastic leukaemia; GVHD = Graft vs Host Disease; VOD = Veno-occlusive disease)

Adolescent↗
PubMed1985

Microangiopathy in Singapore diabetic children.

Nineteen children with insulin-dependent diabetes mellitus were assessed for microangiopathic complications in the University Department of Paediatrics, Singapore. Of 17 who underwent nerve conduction studies, all showed impaired nerve conduction velocities, with more sensory than motor nerve involvement. The extent of neuropathy was significantly correlated with the duration of disease. Of five children who showed significant proteinuria, two had impaired creatinine clearance, two had cataract formation, and two retinopathy, in one background and in one proliferative. Our study showed a high prevalence of microangiopathic complications in these diabetic children and it is hoped that improved blood glucose control, with the aid of home blood glucose monitoring, may minimize or arrest the microangiopathic complications.

Adolescent↗
PubMed1986

Long-term follow-up of a clinical trial of six-month and four-month regimens of chemotherapy in the treatment of pulmonary tuberculosis. Singapore Tuberculosis Service/British Medical Research Council.

In a study in Singapore, patients of Chinese, Malay, or Indian ethnic origin with sputum-smear-positive pulmonary tuberculosis received 2 months of daily treatment with streptomycin, isoniazid, rifampin, and pyrazinamide followed by daily isoniazid and rifampin, either with or without pyrazinamide, allocated at random. Both regimens were given for a total duration of either 6 or 4 months by random allocation. As previously reported, all 330 patients with drug-susceptible strains of tubercle bacilli pretreatment had a favorable bacteriologic response during chemotherapy, and only 2 (1%) of 158 in the 6-month series, compared with 15 (10%) of 156 in the 4-month series, relapsed bacteriologically during the 30 months after the start of chemotherapy. A long-term follow-up assessment has been conducted 5 to 8 yr after admission to the study. The excellent results in the 6-month series were maintained; only 1 of the 138 patients assessed relapsed after 30 months, compared with 5 of the 131 in the 4-month series. Of 33 patients with bacilli resistant to isoniazid, streptomycin, or both drugs pretreatment, 1 had an unfavorable response during treatment, and none of 9 in the 6-month series and 2 of 22 in the 4-month series relapsed bacteriologically by 30 months, but none of the nine 6-month and eighteen 4-month patients assessed relapsed subsequently.

Adolescent↗
PubMed1988

Clinical evaluation of a yeast recombinant hepatitis B vaccine in healthy hospital staff in Singapore.

A yeast recombinant hepatitis B vaccine (subtype adw), derived from purification of HBsAg particles, expressed in the yeast Saccharomyces cerevisiae which contained the gene for HBsAg, was evaluated in 31 healthy adult hospital staff members in Singapore. Each subject received a 10 mcg dose of vaccine intramuscularly at 0, 1 and 6 months. One month after the first two injections of vaccine the seroconversion rate (defined as greater than or equal to 2.7 mIU/ml) was 90%. Two months after the third injection 100% of participants had anti-HBs levels higher than 2.7 mIU/ml and 97% had titers of anti-HBs greater than 10 mIU/ml. The geometric mean titer (GMT) of anti-HBs levels at 2, 3, 6, 8 and 12 months were 21.9, 38.6, 57.6, 1253.4 and 354.1 mIU/ml, respectively. All clinical complaints were mild and transient. They consisted of mild soreness at the injection site, transient fever and headache. There was no correlation between the presence of antibodies to S. cerevisiae with any allergic manifestations. The vaccine was safe and immunogenic for staff exposed to an infection risk and should now be widely used in the extension of hepatitis B immunization programs.

Ethnicity↗
PubMed1988

Middle ear diseases in cleft palate patients in Singapore.

A preliminary prospective study of the correlation between middle ear diseases and cleft palate was started in February 1987. Eighty three patients from the Plastic Surgical Department of the Singapore General Hospital have been screened. Three quarters of the ears screened were normal. Middle ear effusion was the commonest disease especially in younger children found in eighteen of thirty four abnormal ears; all these patients benefited from myringotomy and insertion of a ventilating tube. Other types of middle ear disease included adhesive otitis media, perforation of the eardrum, attic retraction and cholesteatoma; these were found predominantly in older patients. The incidence of middle ear disease was 23% in Chinese patients with cleft palate as compared with up to 90% in Caucasian patients.

Adolescent↗
PubMed1984

Blood donor motivation in Singapore.

75 first time donors were interviewed in detail at their first presentation at the Singapore Blood Transfusion Service. In addition they were asked to complete forms which elicited the motivating factors behind donating blood as well as the Crown Crisp Experiential Index. The results of this study show that the main motivating factor in these donors was that of an altruistic and humanitarian desire to help people. A high proportion (2/3) had some previous personal or familial contacts with the blood service. It also reports these donors as being more social and emotional people. These findings correlate with other studies and have implications for setting up blood donor recruitment programmes.

Adult↗
PubMed1984

Testicular disease in Singapore children with acute leukemia.

A study was made on testicular leukaemia developing in children treated for leukaemia in the Department of Paediatrics, Singapore General Hospital over the past 6 years. Of the 44 cases of acute leukaemia treated, 24 were males, and 6 developed testicular leukaemia, all occurring in patients with acute lymphoblastic leukaemia. Half the cases developed testicular relapse while on chemotherapy with the other half developing it after all chemotherapy was stopped. There is a place for prophylactic radiotherapy to the testis. Testicular biopsy should be considered early in high risk groups.

Antineoplastic Agents↗
PubMed1984

Chronic myeloid leukaemia in Singapore: a case study of 56 patients.

A case study was made on 56 patients with chronic myeloid leukaemia in Singapore. The most common clinical presentations were abdominal discomfort with swelling and hepatosplenomegaly. The mean haemoglobin, white cell count, and platelet count at presentation were 9.23 g/dl, 217.9 X 10(9)/1 and 418 X 10(9)/1 respectively. Twenty-three of the 56 patients had gone into blast transformation at the time of analysis. The median duration of the chronic phase from the time of diagnosis to the time of blast transformation was 23 months. The median duration of survival after blast transformation was 3 months. The median duration of survival for all patients was 23 months. Busulphan remains the drug of choice for the chronic phase of chronic myeloid leukaemia.

Adolescent↗
PubMed1981

Controversies in biliary drainage for choledocholithiasis and cholangiohepatitis in Singapore.

Although fulminating primary cholangitis appears to be less frequently seen in recent years in Singapore, choledocholithiasis continues to be frequently encountered. A proportion of these patients probably represents the less severe forms of primary cholangiohepatitis with primary ductal calculi. These calculi are related to stasis within the bile ducts and an internal biliary drainage procedure appears logical and should be performed. There is a place for each of the drainage procedures, choledochojejunostomy, choledocho-duodenostomy and sphincteroplasty in the treatment of primary duct calculi and cholangiohepatitis. Choledochoduodenostomy is simple, safe and particularly suitable for elderly and poor risk patients and in emergency situations. Sphincteroplasty has the advantage of dependent drainage, permits removal of impacted calculi and may be suitable when the common bile duct is not grossly dilated. Clearer understanding of the pathogenesis of biliary calculi and primary cholangiohepatitis is important to foster a more logical approach in the treatment of the disease.

Aged↗
PubMed1993

Huntington's disease: recent progress in gene mapping and potential local application in Singapore.

Advances in the field of molecular genetics have made testing of individuals for the presence of certain genes possible. Programmes for testing families with Huntington's disease have been developed overseas but not locally. We outline our beginning attempts to make services such as prenatal exclusion testing and presymptomatic carrier detection available to Singapore families with Huntington's disease.

Chromosome Mapping↗
PubMed1993

A retrospective study of cataract surgery in the Singapore General Hospital in 1990.

Nine hundred and ninety-five consecutive cases of cataract extraction with or without lens implantation performed within the first three months of 1990 in the Singapore General Hospital were examined retrospectively. Of the 995 cases, 874 (87.84%) were deemed to have adequate postoperative evaluation at an average of 12.5 months. Of these cases, 79.52% (695 eyes) obtained a visual acuity of 6/12 or better. When cases with pre-existing causes of poor vision were excluded, 90.25% of cases obtained a visual acuity of 6/12 or better. If potentially treatable causes of postoperative poor vision (such as posterior capsule opacification awaiting Nd:YAG laser capsulotomy and high astigmatism prior to suture removal) were further excluded from analysis, this figure would rise to 93.66%. The incidence of posterior capsule rupture was 1.4%. Factors affecting visual success included patient age, lens hypermaturity and duration of surgery.

Adolescent↗
PubMed1997

Stress of caregivers of dementia patients in the Singapore Chinese family.

In a study of 50 family caregivers of elderly Chinese patients with dementia in Singapore, 28 (56%) scored five points or more on the 28-item General Health Questionnaire (GHQ). The GHQ scores correlated significantly with duration of care; presence of delusion, hallucination, depression, insomnia, incontinence and agitation; and the total score of the Behavioural Pathology in Alzheimer's Disease Rating Scale. On multiple regression analysis the only variables to achieve a significant relationship with the GHQ scores were duration of care, depression and the total behavioural score.

Aged↗