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PubMed2005

Kathleen Mears Memorial Lecture: ASET and OSET, patterns and parallels.

OSET is the international Organisation of Societies for Electrophysiological Technology, a federation of professional societies from around the world. Just as ASET grew out of the national physicians' society, OSET grew out of an international physicians' consortium. Both ASET and OSET are independent groups that address the many issues specific to technologists, from entry-level education to standards of practice and legal conditions of practice. The present "members" of OSET are the technologist societies of Australia, Canada, Denmark, Finland, France, Germany, Italy, Netherlands, Norway, Sweden, Switzerland, the U.K., and the U.S.; the individual members of those societies are members of OSET by extension. OSET holds a week-long Congress every four years, hosted by one of the member societies. Technologists from all over the world gather to share information via platform papers and posters. Just as ASET meetings provide an opportunity for technologists to learn from each other, formally and informally, so the OSET Congresses extend that sharing beyond national borders. Between Congresses, OSET work is done by committees. Some of the published results of this committee work are statements of minimal and optimal standards of training in EEG and evoked potentials, guidelines for digital EEG, guidelines for infection control, and guidelines for intraoperative monitoring. The last two Congresses have had sessions on education in the OSET countries; present committee work is continuing to study this issue to develop a truly international statement of competencies, i.e., what technologists must be able to do to perform electrophysiologic studies anywhere in the world.

Allied Health Occupations↗
PubMed2005

2005 Galloway Memorial Lecture: Breast phyllodes tumours--morphology and beyond.

OBJECTIVES: The aims of this study were to evaluate the predictive role of morphology in a series of breast phyllodes tumours (PTs) in Asian women, and to determine the utility of immunohistochemical expression of p53 and CD117 in the stromal component. MATERIALS AND METHODS: Breast PTs, diagnosed between January 1992 and December 2002 at the Department of Pathology, Singapore General Hospital, were classified into benign, borderline and malignant categories. Surgical margins were evaluated as complete or diffusely involved. Patient follow-up was obtained from casenotes and the Singapore Cancer Registry. Tissue microarrays (TMAs) were constructed using the 2-mm punch on the Beecher arrayer. p53 and CD117 immunohistochemistry was applied on 4-microm sections cut from TMA blocks. Immunostaining intensity was graded as 0, 1+, 2+ or 3+, for nil, weak, moderate and strong reactivity. The proportion of stromal cells decorated was assessed. Statistical analysis utilised the software SPSS for windows 11.5. Survival curves were plotted using the Kaplan-Meier method, while multivariate analysis was accomplished using the stepwise Cox proportional hazards model. A P value of <0.05 was considered a significant result. For verification of protein expression results, a pure stromal population derived from laser capture microdissection was subjected to real-time polymerase chain reaction to determine p53 and CD117 mRNA upregulation. RESULTS: Three hundred thirty-five women diagnosed with PT were aged 16 to 69 years (median, 42 years). Tumour size ranged from 0.9 to 25 cm (median, 4 cm). Histologic classification revealed 250 (74.6%) benign, 54 (16.1%) borderline and 31 (9.3%) malignant PTs. Surgical margins were focally involved in 186 (55.5%) cases, diffusely affected in 9 (2.9%) cases and complete in 139 (41.5%) cases. Stromal cells positively stained ranged from 1% to 80% (mean, 15%; median, 5%) for p53, and 1% to 25% for CD117 (mean, 8%; median, 3%). p53 and CD117 staining was associated with PT grade (P = 0.004, P <0.001). Forty-three (12.8%) women suffered 57 recurrences (mean and median follow-up of 30.3 and 20.4 months respectively). Nine (2.7%) died during follow-up, 7 from malignant disease (mean and median survival duration 37.6 and 23.6 months respectively). Complete margins (P = 0.033) resulted in reduced recurrence risk by 51.7%. Though tumour grade was associated with an increased hazard of 1.63, it was not significant (P = 0.28). Immunoexpression of p53 was not associated with recurrence (P = 0.447), while CD117 was (P = 0.001). Upregulation of p53 and CD117 mRNA was found in cases in which there was protein overexpression. CONCLUSIONS: Involved surgical margins remain a key prognostic parameter in breast PT. Death from disease occurred in women with malignant PTs at presentation, underscoring the need to manage this group more aggressively. p53 staining can be used to corroborate malignancy in PT. CD117 was predictive of recurrence, and if further validated, its expression can be explored for therapeutic purposes. Preliminary molecular studies verify mRNA upregulation in p53 and CD117 overexpressed cases.

Adolescent↗
PubMed2005

2005 Distinguished Academician Lecture: Evolution of postgraduate medical education in Singapore--role of professional associations.

From 1910 to 1945, doctors in Singapore received postgraduate training through apprenticeship. During the early post-war period, some doctors in the public service were given scholarships to study in Britain and to obtain higher professional qualifications from the British Royal Colleges. The events that most influenced subsequent development of postgraduate education in Singapore occurred between 1956 and 1969: the formation of the Academy of Medicine and the Singapore Medical Association (SMA); organisation of courses for candidates preparing for examinations of the Royal Australasian and British Colleges; competition between the Academy and the University over responsibility for postgraduate medical education; the inauguration of the School of Postgraduate Medical Studies (SPMS); and the introduction of Master of Medicine (M Med) degrees in various medical specialties. From 1970 to 1999, there was expansion in several aspects of postgraduate medical education: SPMS awarded more than 2000 M Med degrees; the Singapore Medical Council (SMC) established a Register of Specialists and formed a Specialist Accreditation Board; the Academy formed Chapters in 10 specialties and developed Advanced Specialty Training programmes leading to Fellowship of the Academy of Medicine Singapore (FAMS); the SMA formed Societies in some 20 specialties; and a College of Family Physicians was inaugurated. There have been more developments from 2000 to 2005: the University restructured SPMS as a Division of Graduate Medical Studies within the Faculty of Medicine; the SMC implemented compulsory Continuing Medical Education; and the Academy converted 6 of its 10 Chapters into Colleges.

Education, Medical, Graduate↗
PubMed2005

15th Seah Cheng Siang Memorial Lecture: Liver transplantation--lessons learnt and future horizons.

The first clinical successes with liver transplantation by Starzl in 1967 were based on studies showing that in man, organ allografts could induce self-tolerance with the aid of immunosuppression. Overall survival figures were poor until 1983, when cyclosporine was introduced into immunosuppressive regimes, and with the introduction of tacrolimus, results improved even further. With figures for 1-year survival now up to 90%, more attention is being directed to quality of life and the side effects of immunosuppression. Nephrotoxicity along with hypertension and diabetes are of major concern, and a significant number of long-term liver transplant patients are now facing end-stage renal failure. In the majority of conditions transplanted there is also a significant chance of disease recurrence in the graft. Owing to the shortage of cadaver organs, split liver and domino techniques are increasingly utilised. Living donor liver transplantation has also come to the fore, and to minimise potential harm to the donor, new techniques are being developed which will allow greater use of left lobe grafts.

Humans↗