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Leung KY, Bala K, Cho JY, Gokhale S, Kikuchi A, Liang P, Ong CL, Nguyen-Phuoc QB, Wataganara T, Wan YL. Utility and challenges of ultrasound education for medical and allied health students in Asia. Hong Kong Med J 2024; 30:75-79. [PMID: 38327163 DOI: 10.12809/hkmj2210647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Affiliation(s)
- K Y Leung
- Gleneagles Hospital Hong Kong, Hong Kong SAR, China
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong SAR, China
| | - K Bala
- Bangladesh Institute of Ultrasound in Medicine and Research, University of Science and Technology Chittagong, Dhaka, Bangladesh
| | - J Y Cho
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - S Gokhale
- Department of Radiology, Sri Aurobindo Institute of Medical Sciences, Sri Aurobindo University, Indore, India
| | - A Kikuchi
- Department of Obstetrics and Gynecology, Saitama Medical Center, Saitama Medical University, Moroyama, Japan
| | - P Liang
- Department of Ultrasound, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - C L Ong
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Q B Nguyen-Phuoc
- Department of Medical Imaging, Can Tho University Hospital, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - T Wataganara
- Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Y L Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Schuring D, Westendorp H, van der Bijl E, Bol GH, Crijns W, Delor A, Jourani Y, Ong CL, Penninkhof J, Kierkels R, Verbakel W, van de Water T, van de Kamer JB. The NCS code of practice for the quality assurance of treatment planning systems (NCS-35). Phys Med Biol 2023; 68:205017. [PMID: 37748504 DOI: 10.1088/1361-6560/acfd06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 09/27/2023]
Abstract
A subcommittee of the Netherlands Commission on Radiation Dosimetry (NCS) was initiated in 2018 with the task to update and extend a previous publication (NCS-15) on the quality assurance of treatment planning systems (TPS) (Bruinviset al2005). The field of treatment planning has changed considerably since 2005. Whereas the focus of the previous report was more on the technical aspects of the TPS, the scope of this report is broader with a focus on a department wide implementation of the TPS. New sections about education, automated planning, information technology (IT) and updates are therefore added. Although the scope is photon therapy, large parts of this report will also apply to all other treatment modalities. This paper is a condensed version of these guidelines; the full version of the report in English is freely available from the NCS website (http://radiationdosimetry.org/ncs/publications). The paper starts with the scope of this report in relation to earlier reports on this subject. Next, general aspects of the commissioning process are addressed, like e.g. project management, education, and safety. It then focusses more on technical aspects such as beam commissioning and patient modeling, dose representation, dose calculation and (automated) plan optimisation. The final chapters deal with IT-related subjects and scripting, and the process of updating or upgrading the TPS.
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Affiliation(s)
- D Schuring
- Radiotherapiegroep, Radiation Oncology department, Arnhem/Deventer, The Netherlands
| | - H Westendorp
- Isala Hospital, Oncology department, Zwolle, The Netherlands
| | - E van der Bijl
- Radboud University Medical Center, Radiation Oncology department, Nijmegen, The Netherlands
| | - G H Bol
- University Medical Center Utrecht, Radiotherapy department, Utrecht, The Netherlands
| | - W Crijns
- KU Leuven-UZ Leuven, Oncology department, Radiation Oncology, Leuven, Belgium
| | - A Delor
- Institut Roi Albert II, Cliniques universitaires Saint-Luc, Radiation Oncology department, Brussels, Belgium
| | - Y Jourani
- Institut Jules Bordet-Université Libre de Bruxelles, Medical Physics department, Brussels, Belgium
| | - C Loon Ong
- Haga Hospital, Radiation Oncology department, The Hague, The Netherlands
| | - J Penninkhof
- Erasmus MC Cancer Institute-University Medical Center Rotterdam, Radiation Oncology department, Rotterdam, The Netherlands
| | - R Kierkels
- Radiotherapiegroep, Radiation Oncology department, Arnhem/Deventer, The Netherlands
| | - W Verbakel
- Amsterdam University Medical Centers-location VUmc, Radiation Oncology Department, Amsterdam, The Netherlands
| | - T van de Water
- Radiotherapeutic Institute Friesland, Leeuwarden, The Netherlands
| | - J B van de Kamer
- The Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
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3
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Van der Heyden B, Ollers M, Loon Ong C, Verhaegen F, Van Elmpt W. OC-0440: Characterization and clinical evaluation of a novel CT reconstruction to derive electron densities. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30882-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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4
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Gupta A, Thida W, Nazir B, Yeo CSW, Low Y, Ong CL. Isolated fallopian tube torsion in prepubertal females. Med J Malaysia 2015; 70:259-262. [PMID: 26358026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Isolated fallopian tube torsion is an uncommon diagnosis. It is particularly rare in the paediatric and post-menopausal age groups. It lacks pathognomonic symptoms, signs and imaging findings, yet each of these diagnostic steps plays a crucial role in early diagnosis. We describe two cases of isolated fallopian tube torsion in prepubertal females.
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Affiliation(s)
- A Gupta
- K. K. Women's and Children's Hospital, Bukit Timah Road, Singapore.
| | - W Thida
- K. K. Women's and Children's Hospital, Bukit Timah Road, Singapore
| | - B Nazir
- K. K. Women's and Children's Hospital, Bukit Timah Road, Singapore
| | - C S W Yeo
- K. K. Women's and Children's Hospital, Bukit Timah Road, Singapore
| | - Y Low
- K. K. Women's and Children's Hospital, Bukit Timah Road, Singapore
| | - C L Ong
- K. K. Women's and Children's Hospital, Bukit Timah Road, Singapore
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5
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Tang PH, Chang K, Hwang WS, Yeo SHG, Ong CL. Fetal hypothalamic hamartoma with suprasellar arachnoid cyst. Ultrasound Obstet Gynecol 2012; 40:725-726. [PMID: 22371236 DOI: 10.1002/uog.11145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- P H Tang
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore.
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6
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Anil G, Tay KH, Loh SF, Yong TT, Ong CL, Tan BS. Fluoroscopy-guided, transcervical, selective salpingography and fallopian tube recanalisation. J OBSTET GYNAECOL 2012; 31:746-50. [PMID: 22085068 DOI: 10.3109/01443615.2011.593647] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study is a retrospective review of the transcervical fluoroscopy-guided fallopian tube recanalisation (FTR) procedures done in a multi-ethnic south-east Asian population, over 9 years. A total of 100 patients with infertility and documented proximal tubal obstruction (PTO) were referred for FTR. On-table hysterosalpingography under sedation demonstrated true PTO in 96 patients. At selective-salpingography, the PTO cleared in 16 patients; 78 required FTR and two had fimbrial blockage. The technical success rate of FTR was 86.8% and the post-FTR pregnancy rate was 36.84% at a mean follow-up interval of 12.2 months. There were no major, immediate procedure-related complications. There was an ectopic pregnancy in a single treated patient. Fluoroscopy-guided FTR is a safe treatment option in patients with infertility from PTO, with high technical success rate, low complication rate and increased chances of pregnancy; therefore it should be preferred before attempting more expensive and resource-intensive procedures.
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Affiliation(s)
- G Anil
- Department of Radiology, National University Hospital, Singapore.
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7
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Teoh WC, Teo SY, Ong CL. Gastrointestinal stromal tumors presenting as gynecological masses: usefulness of multidetector computed tomography. Ultrasound Obstet Gynecol 2011; 37:107-109. [PMID: 20737452 DOI: 10.1002/uog.8801] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Large extraluminal gastrointestinal tumors (GISTs) may present as pelvic masses and thus mimic gynecological neoplasms in female patients. On clinical examination and pelvic ultrasound, these tumors resemble pedunculated fibroids or ovarian tumors. Multidetector computed tomography (CT), with its ability to perform isotropic multiplanar reconstruction, is useful in differentiating GISTs from true gynecological masses by demonstrating the pedicle sign connecting a pelvic GIST to its organ of origin. This allows a preoperative diagnosis to be made, which may be helpful in guiding therapeutic options and management. We present two cases of GISTs presenting as pelvic masses in which ultrasound findings suggested a gynecological cause, but multidetector CT with multiplanar reconstruction was able to determine their true organ of origin.
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Affiliation(s)
- W C Teoh
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore.
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8
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Chiang LW, Jacobsen AS, Ong CL, Huang WS. Persistent sterile pyuria in children? Don't forget tuberculosis! Singapore Med J 2010; 51:e48-e50. [PMID: 20428732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Genitourinary tuberculosis (GUTB) is exceptionally uncommon among the local paediatric population. A 10-year-old Chinese girl with no risk factors for tuberculosis presented with recurrent sterile pyuria. Despite extensive renal investigations, no apparent cause could be ascertained for her obstructed left drainage system. The diagnosis was eventually confirmed with urine acid-fast bacilli culture, after a computed tomography scan suggested possible renal tuberculosis. Left nephroureterectomy had to be performed owing to deteriorating left kidney function. This report discusses the importance of considering tuberculosis when assessing a local paediatric patient with an atypical urinary tract infection. Early diagnosis of renal tuberculosis can prevent the sequelae of GUTB, including renal impairment.
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Affiliation(s)
- L W Chiang
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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9
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H'ng MWC, Wanigasiri UIDK, Ong CL. Perineural (Tarlov) cysts mimicking adnexal masses: a report of three cases. Ultrasound Obstet Gynecol 2009; 34:230-233. [PMID: 19644949 DOI: 10.1002/uog.6448] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Perineural (Tarlov) cysts are usually incidental findings during magnetic resonance imaging (MRI) performed for low back pain. However, in a tertiary women's hospital, they may present as incidental findings on gynecological ultrasound imaging. Approximately 40,000 pelvic scans are performed annually in our department. Tarlov cysts were identified in three women between August 2007 and September 2008. In two patients (Cases 1 and 3), these cysts were initially misdiagnosed as hydrosalpinges on ultrasound examination, the latter having a differential diagnosis of an ovarian cyst. Two patients (Cases 1 and 2) were symptomatic, although Case 2 had symptoms that could not entirely be accounted for by the location of the cyst. Although asymptomatic, Case 3 underwent laparoscopy with a view to salpingectomy/cystectomy. In these patients, confirmation of Tarlov cysts was subsequently made on either computed tomography (CT) or MRI. All three patients were managed conservatively. Here we describe their clinical presentation, the appearance of the cysts on ultrasound imaging and on CT or MRI, and their eventual outcomes.
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Affiliation(s)
- M W C H'ng
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore.
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Tan BP, Ong CL. Ultrasonographical diagnosis of acute gynaecological pain. Singapore Med J 2008; 49:511-516. [PMID: 18581029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Acute pelvic pain is a common presentation in women. There are a myriad of causes, both gynaecological and non-gynaecological in origin. Ultrasonography is well-established as the primary initial investigation of choice. Familiarity with the imaging features of the commonly-associated conditions aids in the rapid diagnosis, and immediate management of the patient. This article provides a pictorial review of the common gynaecological causes of pelvic pain.
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Affiliation(s)
- B P Tan
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore.
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11
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Eng CW, Tang PH, Ong CL. Hysterosalpingography: current applications. Singapore Med J 2007; 48:368-73; quiz 374. [PMID: 17384889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
With the recent advances in reproductive medicine, hysterosalpingography has become a relatively quick and noninvasive examination to evaluate fallopian tubes and uterine cavity. It remains the best modality to image fallopian tubes. Congenital uterine malformations, technical artefacts and pathological findings are depicted. Pathological findings that can be detected on hysterosalpingography include salpingitis isthmica nodosa, tubal blockage, peritubal adhesion, submucosal leiomyoma, endometrial polyp, endometrial carcinoma, synechiae and adenomyosis.
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Affiliation(s)
- C W Eng
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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12
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Teo SY, Ong CL. Clinics in diagnostic imaging (108). Tuberculous dactylitis of the thumb, mediastinal and left hilar lymphadenopathy, and probable left cervical lymphadenopathy. Singapore Med J 2006; 47:243-9; quiz 250. [PMID: 16518563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
A five-year-old girl presented with a history of left neck swelling for one week and right thumb swelling for three weeks. Imaging studies revealed a "collar-stud" abscess in the left side of the neck, massive mediastinal lymphadenopathy with a left anterior chest wall abscess, and right thumb dactylitis that was typical of tuberculosis (TB). Surgical drainage of the left neck swelling revealed acid-fast bacilli. Young children are more susceptible to tuberculous infection, and at greater risk of extrapulmonary spread. A child infected with TB indicates recent transmission, usually from an adult. Good contact tracing is essential. Individuals with HIV infection are also at greater risk of TB and atypical mycobacterial infection as well extrapulmonary TB. The clinical and radiological features of both pulmonary and extrapulmonary TB are discussed, with additional illustrative cases.
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Affiliation(s)
- S Y Teo
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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13
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Prasad TRS, Chui CH, Ong CL, Meenakshi A. Cervical ectopic thymus in an infant. Singapore Med J 2006; 47:68-70. [PMID: 16397725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Cervical ectopic thymus, a common embryological anomaly detected incidentally at autopsy, is rarely described in clinical patients. About 100 cases have been described in the literature, ten percent of which occurred in neonates. We report a case of solid cervical ectopic thymus in a three-month-old male infant presenting as a neck lump and snoring at sleep. The embryopathogenesis, clinical features, diagnostic modalities and management options are discussed, together with a review of the literature.
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Affiliation(s)
- T R S Prasad
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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14
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Lee W, Ong CL, Chong CCL, Hwang WS. Omental infarction in children: imaging features with pathological correlation. Singapore Med J 2005; 46:328-32. [PMID: 15968444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Omental infarction is a rare occurrence in the paediatric population. It often presents as an acute abdomen that can mimic acute appendicitis and cholecystitis. METHODS Six cases of omental infarction in children, proven on histopathology, were retrospectively reviewed for their clinical presentation and imaging findings on ultrasonography and computed tomography. RESULTS These cases revealed clinical and imaging findings on computed tomography that were suggestive and helpful in the pre-operative diagnosis of omental infarction. Findings on ultrasonography were less specific. Histopathological specimens revealed findings of vasculitis in all cases. CONCLUSION There are clinical and imaging features that will help in the pre-operative diagnosis of this uncommon condition. We also postulate vasculitis as a possible underlying pathology for omental infarction.
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Affiliation(s)
- W Lee
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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15
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Ong CL. Pitfalls of gynaecological ultrasonography. Singapore Med J 2004; 45:289-94. [PMID: 15181526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Pitfalls in gynaecological ultrasonography may arise during acquisition of images, processing and interpretation. Physical interactions between the ultrasound and body structures may produce artifacts. Physiological processes such as functional ovarian cysts may mimic lesions. Different pathological processes may produce similar ultrasonographical appearances. To minimise errors in interpretation of gynaecological ultrasonography, one needs to be aware of the limitations of ultrasonography, and the similarities in the appearances of various physiological and pathological processes.
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Affiliation(s)
- C L Ong
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
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Chen JSC, Walford N, Yan YL, Ong CL, Yeo GSH. Foetal intralobar lung sequestration: antenatal diagnosis and management. Singapore Med J 2003; 44:630-4. [PMID: 14770257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES The objectives of this study are to discuss the use of ultrasonography for the diagnosis of foetal intralobar sequestration (FILS) antenatally and the management options available for these pregnancies. METHODS This is a retrospective review of six cases of FILS diagnosed antenatally by two dimensional (2D) and colour Doppler ultrasonography out of a total of 31,508 deliveries over a two-year period at the KK Women's and Children's Hospital. RESULTS The incidence of FILS in this hospital was 1 in 5,251 deliveries. 2D ultrasonography showed an echogenic lung in all cases. FILS was confirmed by the demonstration of a systemic vessel leading to the affected lung on colour Doppler examination. After counselling, four terminated their pregnancies during mid-trimester, while two continued their pregnancies to term. Confirmation of the terminated cases was by post-mortem. In the two pregnancies that continued, regular growth scans were done to monitor the progression of the condition. Computed tomography confirmed the diagnosis post-delivery. Both were well but one had a resection of the sequestrated lung although he was asymptomatic. Histology also confirmed the diagnosis. CONCLUSION FILS is a rare anomaly. 2D and colour Doppler ultrasonography are used to diagnose the condition antenatally. Termination of the pregnancy is not always indicated, as there are favourable outcomes from FILS.
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Affiliation(s)
- J S C Chen
- Department of Maternal-Foetal Medicine, KK Women's and Children's Hospital (KKWCH), 100 Bukit Timah Road, Singapore 229899.
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Ho SP, Ong CL, Tan BS. A case of uterine artery pseudoaneurysms. Singapore Med J 2002; 43:202-4. [PMID: 12188066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Uterine artery pseudoaneurysms is a rare cause of haemorrhage but is potentially life-threatening and can occur after common gynaecological operations such as a Caesarean section or a hysterectomy. A 33-year-old woman who developed secondary postpartum haemorrhage after a Caesarean section was diagnosed to have uterine artery pseudoaneurysms on ultrasound scan. She was treated with bilateral uterine artery embolisation via selective catherisation of uterine arteries. Good outcome with the aneurysms remaining obliterated was obtained. Angiographic embolisation is a safe and effective method of treating postpartum haemorrhage in haemodynamically stable patients and should be an option before resorting to surgery in appropriately selected cases.
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Affiliation(s)
- S P Ho
- Division of O&G, KK Women's & Children's Hospital, Singapore.
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18
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Teo EL, Tan KP, Lam SL, Ong CL, Wong CS. Ultrasonography and computed tomography in a clinical algorithm for the evaluation of suspected acute appendicitis in children. Singapore Med J 2000; 41:387-92. [PMID: 11256346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
AIM To evaluate the roles and effectiveness of US and CT in a clinical algorithm for the evaluation of children with suspected appendicitis. METHODS Patients with suspected appendicitis were prospectively evaluated with ultrasound (US), and in some cases with CT, after they were graded to have high, intermediate or low clinical likelihood for appendicitis. Imaging findings were made known to clinicians who then decided on a line of management. Patho-histological examination and clinical follow-up established the final diagnoses, which were correlated with the imaging findings. The effect of imaging on the management of patients was examined. RESULTS Overall, the sensitivity of US was 92.9%, specificity 96.9%, accuracy 96.0%, positive predictive value 89.7% and negative predictive value 97.9%. Imaging did not affect the decision to operate in 13/14 (92.9%) patients in the high likelihood subgroup. Imaging guided the clinicians to the right management pathway in 26/30 (86.7%) patients in the intermediate group. 77/82 (93.9%) of US was truly negative in the low likelihood group. CT was performed in 12 patients because of unsatisfactory US scans or incompatibility between the US and the clinical findings. CT correctly diagnosed the presence or absence of appendicitis in all 12 patients. CONCLUSION US and CT are accurate modalities in the diagnosis of acute appendicitis in children. US is most useful in patients with equivocal clinical findings. US should be the first modality used to evaluate children with suspected appendicitis. CT should be reserved for cases where US is sub-optimal or where the findings are inconsistent with the clinical findings.
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Affiliation(s)
- E L Teo
- Department of Diagnostic Imaging, Paediatric Surgery, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
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Abstract
A case is described of vaginal bleeding in a 67-year-old female as the first manifestation of a uterine arteriovenous malformation (AVM). Although bleeding is the commonest presentation of an AVM, this is the first case known to have been precipitated by florid myometritis associated with the long-standing presence of an intra-uterine contraceptive device (IUCD). Uterine imaging studies utilising ultrasound scan with color Doppler were instrumental in suggesting the source of bleeding in this case. Subsequently, the patient suffered a torrential hemorrhage which necessitated hysterectomy.
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Affiliation(s)
- I Busmanis
- Department of Pathology, Kandang Kerbau Women's and Children's Hospital, Singapore
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Abstract
The case of an echogenic mass in the right lung that apparently resolved spontaneously prior to delivery is reported here. Postnatal investigations revealed congenital lobar emphysema. To the knowledge of the authors, this is the first reported case of spontaneous, apparently complete resolution of an echogenic lung mass on antenatal ultrasound due to lobar emphysema. The routine use of ultrasound to screen for foetal anomalies has led to the discovery of a number of incidental findings, such as an echogenic foetal lung mass, that pose a challenge to diagnosis and management. The importance of appropriate counselling and postnatal follow-up are highlighted.
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Affiliation(s)
- G K Wansaicheong
- Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, Singapore.
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Abstract
BACKGROUND This study was undertaken to determine the incidence of preventable trauma death at a non-designated trauma centre in Singapore. METHODS A retrospective audit was carried out on all trauma deaths that occurred between January 1993 and December 1994 at the National University Hospital, Singapore. Of the 138 deaths, 38.4% (53/138) of patients were dead on arrival and were omitted from the study. Data from the remaining 85 deaths were summarized and presented before a multidisciplinary review board and injuries were scored according to the Abbreviated Injury Scale (AIS). RESULTS Except for one patient, all deaths had an AIS score of 16 or greater. Sixty-one per cent (52/85) of deaths were the result of severe head injuries, and the rest had severe injuries in more than one body region. Following the guidelines of the Trauma Research and Education Foundation of San Diego, the incidence of 'not preventable', 'potentially preventable' and 'frankly preventable' deaths were 77.6, 15.3 and 7.1%, respectively. The most common errors in management were caused by delays in inter-departmental transfer (25.9%) and missed initial diagnosis (16.5%). After assessment by the Coroner's Office, autopsies were carried out in 60% of the cases and yielded information that altered the assessment of preventable deaths, particularly in the group with multiple injuries. CONCLUSIONS The present study concludes that the preventable death rates in the National University Hospital are comparable to those in non-trauma designated centres elsewhere. There can only be a decrease in the preventable death rate if an improved system of pre-hospital trauma care, improved interdisciplinary communication, closer supervision of the initial attending physicians and stricter protocols on clinical monitoring are established.
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Affiliation(s)
- P T Iau
- Department of Surgery, National University Hospital, Singapore.
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Razvi K, Ong CL, Chua S, Chia YT, Ratnam SS, Arulkumaran S. Necrotising fasciitis originating from a vulval abscess--a case report. Singapore Med J 1998; 39:226-8. [PMID: 9713231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This article reports a rare case of necrotising fasciitis starting out as a vulval abscess with rapid progression to a potentially lethal condition. Elderly people with medical conditions such as diabetes are especially prone to it. A high index of suspicion and an early surgical consult are essential in improving outcome in this condition. Once diagnosed, aggressive surgical debridement with antibiotic cover is crucial. This is followed up with meticulous nursing care of the large wound till it heals. The various diagnostic points and treatment modalities are also discussed.
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Affiliation(s)
- K Razvi
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore
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Khalil L, Ho KH, Png D, Ong CL. The effect of enteral fibre-containing feeds on stool parameters in the post-surgical period. Singapore Med J 1998; 39:156-9. [PMID: 9676145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND/AIM OF STUDY Specialised nutritional support includes both enteral and parenteral routes. When oral intake is not an option, but gastro-intestinal function is present, enteral tube feeding should be considered. However, one of the complications of enteral feeding access is diarrhoea. The aim of this study was to test the effect of fibre on a local population, in a prospective, single-blinded trial to determine whether the presence of fibre in enteral feeds reduced the incidence of diarrhoea in Asian patients. METHODS Sixteen post-surgical candidates were randomly assigned to receive a fibre-supplemented (FSF) enteral formula or a fibre-free formula (FFF) for 10 days post-surgery to assess the usefulness of FSF in reducing the incidence of diarrhoea in tube-fed patients. Differences in stool consistency, stool frequency, capillary blood glucose and serum albumin levels between the two groups were determined. Antibiotic usage in both groups was noted. RESULTS Patients in the FSF group had more bowel movements throughout the 10-day period and firmer stools than the FFF group, but this difference was not statistically significant (p = 0.39). There were no significant differences in daily mean glucose levels between both groups. CONCLUSION We conclude that there is insufficient evidence that fibre-containing enteral formulae reduce the incidence of diarrhoea in tube-fed patients in the short term. However, these products could inherently be included for patients on tube-feeds during extended periods, with the prospect of maintaining gut function integrity and flora.
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Affiliation(s)
- L Khalil
- Dietetics Department, National University Hospital, Singapore
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24
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Wansaicheong GK, Ong CL. Intramural tubal polyps--a villain in the shadows? Singapore Med J 1998; 39:97-100. [PMID: 9632965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intramural tubal polyps are commonly described in association with subfertility. However, there is unfamiliarity among clinicians about the investigations available for making a diagnosis of this condition. The objective of this paper was to highlight the suitable investigations for diagnosis and thus increase awareness of this condition and its relationship with subfertility. METHOD A retrospective review of 14 patients with intramural tubal polyps was done for the period from January to December 1996. An attempt was made to correlate the radiographic findings on hysterosalpingography with transvaginal ultrasound examinations and hydrochromotubation performed under laparoscopic observation. The fertility history of these patients was also examined. RESULTS The review demonstrated a prevalence of 3.8% of intramural tubal polyps in a selected population of predominantly subfertile women. Only hysterosalpingography was useful in making the diagnosis in-vivo. Fifty percent of the patients did not have any other obvious pathology to explain their subfertility. CONCLUSION We conclude that meticulous hysterosalpingography is useful as a diagnostic investigation and that consistent reporting is needed for good follow-up.
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Affiliation(s)
- G K Wansaicheong
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore
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Affiliation(s)
- C L Ong
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
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Affiliation(s)
- C L Ong
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore, Singapore
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Png DJ, Ong CL, Chan S. Surgical Nutritional Team and its impact on total parenteral nutrition in The National University Hospital, Singapore. Int J Clin Pract 1997; 51:350-2. [PMID: 9489060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Surgical Nutrition Advisory Team (SNAT) of our hospital, formed in October 1992, decided to study the impact of such a team on the six months before and after its formation on catheter care and nutritional support in total parenteral nutrition. Our study showed that with a dedicated nutritional team, catheter sepsis was reduced from 35.1% to 15.4%. The median lifespan of central catheters was increased from 7 to 11 days. Mechanical complications were reduced from 11% to zero. Better patient selection resulted in more severely malnourished patients receiving preoperative nutrition and fewer postoperative patients being started on total parenteral nutrition. Better monitoring of nutritional requirements, electrolyte and metabolite levels and consequently faster correction of abnormal blood levels, were also obtained.
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Affiliation(s)
- D J Png
- Department of Surgery, National University Hospital, Singapore
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28
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Chong KT, Ong CL. Cystic hygroma in adulthood. Singapore Med J 1997; 38:261-2. [PMID: 9294340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The majority of cystic hygromas present in childhood, usually below the age of two years. A case report of adult presentation is presented, with discussion of development, presentation, pathology and management of cystic hygroma.
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Affiliation(s)
- K T Chong
- Department of Surgery National University Hospital, Singapore
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29
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Fok CM, Reynolds VB, Tan KA, Ong CL, Chong PY. Clustered intramammary microcalcifications not associated with a mass. Singapore Med J 1995; 36:29-31. [PMID: 7570130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Over a period of two and a half years, 36 biopsies performed for clustered microcalcifications not associated with a mass revealed 30 benign and 6 malignant lesions. Of the 30 benign cases, 4 showed histological features which are thought to be associated with an increased risk of developing carcinoma. As similarities can exist in the mammographic appearances between benign and malignant microcalcifications, clusters of microcalcifications showing overlapping features or increasing in number over time require histopathologic study as there is no radiologic means at present of predicting which cluster will be malignant. We observe that our Chinese female population has a tendency towards dense breast parenchyma often associated with microcalcifications, both scattered and clustered. The presence of these clustered microcalcifications prompts biopsy even though the yield for malignancy is anticipated to be low.
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Affiliation(s)
- C M Fok
- Department of Diagnostic Imaging, National University Hospital, Singapore
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Ong CL, Png DJ, Chan ST. Abdominal trauma--a review. Singapore Med J 1994; 35:269-70. [PMID: 7997901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Trauma is a leading cause of death in the 1-44 age group. In our study, the most common cause is road traffic accidents followed by stab wounds and falls from height. Blunt abdominal trauma accounted for 79% of the cases. The spleen and liver were the most common organs involved in blunt abdominal trauma. Clinical assessment of blunt abdominal trauma is unreliable. The diagnostic peritoneal lavage is a useful triage tool in the initial assessment.
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Affiliation(s)
- C L Ong
- Department of Surgery, National University Hospital, Singapore
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Ho NK, Ong CL. Renal candidiasis: possible aetiology for fungal ball formation. J Paediatr Child Health 1993; 29:483-4. [PMID: 8286174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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33
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Ong CL, Ti TK, Rauff A. Primary gastric lymphoma. Singapore Med J 1993; 34:442-4. [PMID: 8153695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Primary gastric lymphoma is a rare gastrointestinal lymphoma. The treatment of this condition remains controversial, especially the extent of surgical resection. Ten cases were operated on over a five-year period at our institution and the outcome was reviewed. Early results suggest no difference in survival whether the margin of resection was clear or not so long as postoperative chemotherapy was given. The outcome appear to depend more on the extent of the disease at the time of surgery. Full thickness involvement of the stomach wall with lymph node involvement were bad prognostic indicators.
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Affiliation(s)
- C L Ong
- Department of Surgery, National University Hospital, Singapore
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34
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Ng HN, Ong CL. Two case reports of intracranial teratoma diagnosed antenatally. Ann Acad Med Singap 1993; 22:823-5. [PMID: 8267369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two cases of foetal intracranial teratoma, diagnosed by antenatal ultrasound, are described. One is a mature teratoma while the other an immature form. The first case presented as epignathus with extracranial extension. Very few cases of fetal intracranial teratoma have been reported. These are uniformly fatal. A review of reported cases indicates that prenatal intracranial teratoma can be accurately diagnosed. Prenatal diagnosis would allow for multidisciplinary team approach and planned delivery in a tertiary care centre.
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Affiliation(s)
- H N Ng
- Department of Diagnostic Imaging, Kandang Kerbau Hospital, Singapore
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Chow LW, Ong CL, Png DJ, Loh TK, Rajagopalan R. Fournier's gangrene. Br J Clin Pract 1993; 47:277-8. [PMID: 8292484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Fournier's gangrene was traditionally thought to arise spontaneously. More recently, cases with urological, perianal or systemic predisposing causes have been reported. This report describes four cases of Fournier's gangrene, all associated with a predisposing cause: two with diabetes mellitus, two secondary to urinary tract pathologies, and one secondary to an infected wound after an inguinal herniorrhaphy.
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Affiliation(s)
- L W Chow
- Department of Surgery, National University Hospital of Singapore
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36
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Chow WC, Ong CL, Png JC, Rauff A. Gall bladder empyema--another good reason for early cholecystectomy. J R Coll Surg Edinb 1993; 38:213-5. [PMID: 7693930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Over an 18-month period, 31 cholecystectomies were performed for empyema of the gall bladder. Analysis of these 31 cases showed that clinical features referable to the diagnosis and seriousness of this condition were few. The presence of a gall bladder mass was detected in only 35% of patients. In adopting a policy of early cholecystectomy for patients admitted for acute gall bladder disease, a low mortality rate of 3.2% was achieved for this group of patients with empyema of the gall bladder. Based on these results, we found that empyema of the gall bladder is another good reason to support early cholecystectomy.
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Affiliation(s)
- W C Chow
- Department of Surgery, National University Hospital, National University of Singapore
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37
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Chow LW, Ong CL, Png DJ. Massive rectal bleeding from an ulceration in a jejunal diverticulum. J Clin Gastroenterol 1993; 17:85-6. [PMID: 8409307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- L W Chow
- Department of Surgery, National University Hospital, Singapore
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38
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Wong TH, Ong CL, Tan WT, Rauff A. The solitary thyroid nodule revisited. Ann Acad Med Singap 1993; 22:593-7. [PMID: 8257066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A series of 195 clinically solitary thyroid nodules is presented and compared with a matching series reported a decade ago. Changes in the pattern of presentation, preoperative diagnosis and options of operative management are highlighted. Although the pattern of presentation has not changed significantly over the last decade, there was a shift noted towards reliance on fine needle aspiration for preoperative diagnosis. The false negative rate was two percent in this series and there were no false positives. There was also a shift towards more conservative surgery in the form of "nodulectomies" in the present series compared to the previous one. The incidence of malignancy in this series was 10.2 percent.
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Affiliation(s)
- T H Wong
- Department of Surgery, National University of Singapore
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39
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Ong CL, Rauff A. Carcinoma of the pancreas--bypass versus resection? J R Coll Surg Edinb 1993; 38:149-51. [PMID: 7687675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The surgical treatment of carcinoma of the pancreas remains controversial. Over a 5-year period, 38 patients with histologically proven carcinoma of the pancreas who were operated on were studied to assess the length of survival. Seven were subjected to a 'curative' resection, 27 subjected to a palliative bypass procedure and four had a laparotomy and biopsy only. The mean survival was 8.7 months for the first group, 8.1 for the second and only 1.6 for those subjected to a laparotomy and biopsy only.
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Affiliation(s)
- C L Ong
- Department of Surgery, National University Singapore
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40
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Chow LW, Loh TK, Ong CL. Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis. Br J Surg 1993; 80:673. [PMID: 8518915 DOI: 10.1002/bjs.1800800543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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41
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Abstract
Gall bladder perforation is a rare complication of cholecystitis. A definitive diagnosis is uncommon before surgery and the morbidity and mortality associated with this condition are high. We report six patients with gall bladder perforation to show the difficulty of making an early diagnosis. The history and the clinical findings of these patients are reviewed to highlight diagnostic pitfalls.
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Affiliation(s)
- C L Ong
- Department of Surgery, National University Hospital, Singapore
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42
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Abstract
Five hundred twenty four consecutive barium enemas done over an 18-month period were reviewed in Singapore to ascertain the prevalence and distribution of diverticular disease in the large bowel. In this study, the prevalence rate was 20 percent, which is comparable to European and American studies but higher than similar studies in Asian countries. However, the distribution of the disease showed a predominance of right-sided disease (70 percent). This is a pattern that is markedly different from that seen in Europe and North America, where the disease involves largely the left side of the large bowel. The high prevalence rate in this series is at variance with the widely held belief that diverticulosis occurs less frequently in oriental communities.
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Affiliation(s)
- J G Chia
- Department of Surgery, National University Hospital, National University of Singapore
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Abstract
Endometriotic involvement of the bladder, although uncommon, is being reported in the literature with increasing frequency. Three cases are presented which will serve to highlight the main features of the disease and its management.
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Affiliation(s)
- C L Ong
- Department of Surgery, National University Hospital, Singapore
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Abstract
A male newborn infant with a giant epignathus associated with intracranial teratoma and obstructive hydrocephalus detected antenatally is reported. Only 4 similar cases have been reported in the literature. This disorder is uniformly lethal. We believe this is the first reported case of epignathus with congenital intracranial teratoma diagnosed antenatally by ultrasonography.
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Affiliation(s)
- A T Ang
- Neonatal Unit, Kandang Kerbau Hospital, Singapore
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45
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Abstract
Thirty-five cases of advanced gastrointestinal malignancies were treated with the Nd-YAG laser for palliation of symptoms. Of the 35, 34 experienced good relief of their symptom. There were no major complications and minor complications occurred in four. The Nd-YAG laser was an efficacious means of providing symptomatic relief for such patients.
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Affiliation(s)
- C L Ong
- Department of Surgery, National University Hospital, Singapore
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46
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