Singapore Med J

Anomalous pancreatico-biliary junction--a non-dilated biliary system and gallbladder carcinoma.

Year 1998
Toufeeq Khan TF. Hayat FZ. Muniandy S.
Department of Surgery, Hospital University Sains Malaysi, Kelantan, Malaysia.
Anomalous pancreatico-biliary junction (APBJ) is commonly associated with cystic dilatation of the bile ducts but recently, several cases without the cystic dilatation have been reported. We treated a young female patient with intractable back and epigastric pain of three months duration. The spine was normal on magnetic resonance imaging (MRI), but several lymph nodes were seen around the coeliac axis. An APBJ, a non-cystic biliary system, non-filling of the gallbladder and an irregular right margin of the bile duct were evident on endoscopic retrograde pancreatography (ERCP), which was highly suggestive of gallbladder (GB) malignancy. At surgery, the GB was hard with local infiltration of the bile duct. Numerous large para-aortic and supraduodenal lymph nodes were present and only a biopsy was possible. Details of the case are presented and the growing etiological importance of an APBJ, especially without cystic biliary dilatation in gallbladder carcinogenesis is discussed.

Left mesocolic hernia or peritoneal encapsulation?--a case report.

Year 1998
Kyaw K.
Department of Surgery, University Hospital, Kelantan, Malaysia.
This is a case report of an 11-year-old boy with left mesocolic hernia. This condition is very similar to peritoneal encapsulation and a literature review of both conditions is done. Confusion among authors in naming them accordingly is addressed.

Spiral computed tomography demonstration of active haemorrhage in blunt abdominal trauma.

Year 1998
Sitoh YY. Sitoh MP.
Department of Diagnostic Imaging, Tan Tock Seng Hospital, Singapore.
In blunt abdominal trauma, patients may still be actively bleeding despite being physiologically stable. Fast computed tomography scanning permits the detection of active haemorrhage by localising the site of extravasation of contrast enhanced blood. Though a specific sign of active bleeding, particularly arterial haemorrhage, it is insensitive to the slow, continuous venous oozing associated with retroperitoneal and pelvic skeletal injuries. However, its presence will have a critical influence on further surgical intervention. The imaging features of this uncommon entity are demonstrated in our case report.

Complicated varicella zoster infection in 8 paediatric patients and review of literature.

Year 1998
Phuah HK. Chong CY. Lim KW. Cheng HK.
Department of Paediatrics, Tan Tock Seng Hospital, Singapore.
BACKGROUND: This is a study of complicated varicella zoster infection in paediatric patients. AIM: To find out the number of patients with such complications, the types of complications and their outcome. METHOD: This involved a retrospective review of the case records of 8 patients who presented to our unit over a 12-month period (Jan-Dec 96). All patients were previously well without any underlying immunodeficiency. Varicella zoster (VZ) infection was confirmed by VZ immunofluorescence from vesicular fluid. RESULTS: CMS complications accounted for 6 of the 8 cases. Of these, 3 presented with encephalitis, 2 with cerebella ataxia and 1 with aseptic meningitis and cerebella ataxia. Of the non-CNS cases, 1 presented with glomerulonephritis with superimposed staphylococcus infection of skin ulcers; the other had disseminated VZ infection with haemorrhagic vesicles, hepatitis, ileus with mesenteric adenitis and disseminated intravascular coagulation. OUTCOME: The patient with disseminated VZ infection and multiple organ involvement died 5 days after a stormy course. One patient with encephalitis who had status epilepticus for 2 hours had behavioural problems and poor memory. The remaining 6 patients had no sequelae. CONCLUSION: VZ infection usually a minor illness, can result in serious life-threatening complications in previously healthy patients.

The current understanding of continence and defecation.

Year 1998
Nyam DC.
Department of Colorectal Surgery, Singapore General Hospital, Singapore.
Problems of continence and defecation are encountered in all facets of medical practice. Yet, the anorectum is cloaked by misunderstanding. Recent research has shed new light on this subject and newer concepts based on systematic investigations have paved the way to a rational approach. Motor function of the anorectum can now be delineated by manometry, electromyography and nerve stimulation. More complex functions like the coordination for continence and defecation are measured using other studies including defecating proctography, scintigraphic balloon topography, scintigraphic evacuation and colonic transit. The amalgamation of data from these studies have led to a logical sequence for the maintenance of normal continence and defecation that is developed in this manuscript based on our current understanding of anorectal motility and physiology. This allows patients who are resistant to straightforward diagnosis to be selected for specialised tests resulting in categorisation and a rational management strategy for their problems.