Nasopharyngeal cancer (NPC) is a unique disease that shows clinical behaviour, epidemiology and histopathology that is different from that of other squamous cell carcinomas of the head and neck. Magnetic resonance imaging (MRI) is now the preferred imaging modality in the assessment and staging of NPC, especially in relation to its superior soft tissue contrast, ability to demonstrate perineural tumour spread, parapharyngeal space, bone marrow involvement and its ability to show the involvement of adjacent structures, such as the adjacent paranasal sinuses and intracranial extension. An understanding of its patterns of spread and the criteria used in the AJCC TNM staging system is important to relay the relevant information to the referring clinician, so that appropriate treatment planning decisions may be made. In this article, the various features of NPC that are pertinent to staging and treatment planning will be discussed, inclusive of locoregional spread, nodal involvement and metastatic disease.
Humans ; Magnetic Resonance Imaging ; Nasopharyngeal Neoplasms ; diagnosis ; pathology ; therapy ; Nasopharynx ; anatomy & histology ; Neoplasm Staging ; Positron-Emission Tomography

INTRODUCTIONHealth-related quality of life is an important aspect of health outcome. The assessment of it must be done by validated instruments. There is no published data on the validity, reliability and sensitiveness to change of the official Chinese translation of the Functional Assessment of Cancer Therapy-General (version 4; FACT-G).

MATERIALS AND METHODSA Chinese questionnaire package comprising the FACT-G and Functional Living Index-Cancer (FLIC, which was translated, modified and validated in Singapore) was filled in by 165 ethnic Chinese patients recruited from the National Cancer Centre, Singapore. Four weeks later, the patients were assessed again by a postal questionnaire survey.

RESULTSThe FACT-G and FLIC total scores were strongly correlated (r = 0.85). The Physical, Social/Family, Emotional and Functional Well-being scales of the FACT-G converged to and diverged from FLIC components as conceptually expected. The FACT-G and its 4 scales also demonstrated known-groups validity in differentiating patients with different performance status (each P <0.001). Their internal consistency ranged from 0.81 to 0.93 and test-retest reliability ranged from 0.74 to 0.85. The FACT-G and its Physical, Emotional and Functional Well-being scales showed trends of change in relation to change in performance status. The Social/Family Well-being scale was sensitive to decline but not improvement in performance status.

CONCLUSIONSThe Chinese version of the FACT-G can be used to assess overall level and some specific aspects of health-related quality of life. However, researchers should be cautious in using this instrument to specifically investigate the social aspect of quality of life.

China ; ethnology ; Female ; Humans ; Language ; Male ; Middle Aged ; Neoplasms ; therapy ; Outcome Assessment (Health Care) ; Quality of Life ; Sensitivity and Specificity ; Singapore ; Surveys and Questionnaires

INTRODUCTIONSevere 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 METHODSWe 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.

RESULTSA 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.

CONCLUSIONSIn 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 ; Child, Preschool ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Radiography, Thoracic ; methods ; Retrospective Studies ; Severe Acute Respiratory Syndrome ; diagnostic imaging ; epidemiology

INTRODUCTION: Isolated oval window atresia (OWA) is a rare cause of congenital conductive middle ear deafness and may be overlooked owing to the normal appearance of the external ear. This anomaly has been previously described, although the published numbers with both imaging and surgical findings are few. Our aim is to correlate the imaging features of OWA with intraoperative findings. MATERIALS AND METHODS: This is a single-centre retrospective evaluation of patients who were diagnosed with OWA and who received surgery from January 1999 to July 2006. No new case was diagnosed after 2006 to the time of preparation of this manuscript. High resolution computed tomography (HRCT) imaging of the temporal bones of the patients were retrospectively evaluated by 2 head and neck radiologists. Images were evaluated for the absence of the oval window, ossicular chain abnormalities, position of the facial nerve canal, and other malformations. Imaging findings were then correlated with surgical findings. RESULTS: A total of 9 ears in 7 patients (two of whom with bilateral lesions) had surgery for OWA. All patients had concomitant findings of absent stapes footplate with normal, deformed or absent stapes superstructure and an inferiorly displaced facial nerve canal. HRCT was sensitive in identifying OWA and associated ossicular chain and facial nerve abnormalities, which were documented surgically. CONCLUSION OWA is a rare entity that can be diagnosed with certainty on HRCT, best visualised on coronal plane. Imaging findings of associated middle ear abnormalities, position of the facial nerve canal, which is invariably mal-positioned, and associated deformity of the incus are important for presurgical planning and consent.

INTRODUCTION: To describe the maternal and fetal outcomes in systemic lupus erythematosus (SLE) pregnancies followed-up in a single tertiary referral centre. METHODS: We performed a retrospective cohort study of 75 SLE pregnancies who were followed up in Singapore General Hospital over a 16-year period from 2000 to 2016. Adverse fetal and maternal outcomes including preterm delivery, miscarriages, fetal growth restriction, congenital heart block, neonatal lupus, pre-eclampsia and SLE flares were obtained from the medical records. RESULTS: The mean age at conception was 32 years old (SD 3.8). The mean SLE disease duration was 5.9 years (SD 5.2). The majority (88%) had quiescent SLE disease activity at baseline. Most pregnancies resulted in a live birth (74.7%). The mean gestational age at birth was 37.4 weeks (SD 3.4). Adverse fetal outcomes occurred in 53.3%. Preterm delivery (33.9%), miscarriages (20%) and fetal growth restriction (17.3%) were the most frequent adverse fetal outcomes. There was 1 neonatal death and SLE flares occurred in a third (33%). In the subgroup of SLE pregnancies with antiphospholipid syndrome, there were higher SLE flare rates (40%) and adverse fetal outcomes occurred in 8 pregnancies (80%). There were no predictive factors identified for all adverse fetal and maternal outcomes. In the subgroup analysis of preterm delivery, anti-Ro (SS-A) antibody positivity and hydroxychloroquine treatment were associated with a lower risk of preterm delivery. CONCLUSION Although the majority had quiescent SLE disease activity at baseline, SLE pregnancies were associated with high rates of adverse fetal and maternal outcomes.

INTRODUCTION: Thyroid fine-needle aspiration cytology (FNAC) is an established investigation for the preoperative evaluation of thyroid nodules and is often done under ultrasonography guidance. While its accuracy has been widely reported, there is little evidence in the literature on the approach to non-diagnostic cytology results. In our study, we aimed to determine the diagnostic performance of ultrasonography-guided thyroid FNAC for the preoperative diagnosis of thyroid cancer at our institution and evaluate the significance of a non-diagnostic thyroid FNAC. METHODS: We retrospectively reviewed the thyroid ultrasonography studies and medical records of all patients who underwent both thyroid FNAC and subsequent thyroid surgery at our institution from 2011 to 2013. FNAC results were correlated with the final histological diagnosis from surgery and the ultrasonography studies were reviewed for suspicious sonographic features. RESULTS: FNAC predicted malignancy with sensitivity, specificity, positive predictive value, negative predictive value, false positive rate, false negative rate and total accuracy of 90.7%, 53.6%, 43.3%, 93.7%, 46.4%, 9.3% and 64.1%, respectively. We found that only one of 26 nodules with non-diagnostic FNAC results was proven malignant on a second FNAC and subsequent thyroidectomy. CONCLUSION The accuracy of ultrasonography-guided FNAC at our institution was comparable to that reported in the literature. There appears to be very low probability of malignancy in sonographically benign nodules with initial non-diagnostic FNAC results.

INTRODUCTIONAlthough research is widely considered to be a relevant and essential skill to resident development, the actual participation rate of residents in research remains low, and the factors associated with participation are unclear.

METHODSWe examined the participation rate of junior residents in research, and their attitudes and perceived barriers toward research, via an anonymised survey carried out from October to November 2013. The residents were from an established Accreditation Council for Graduate Medical Education-accredited internal medicine residency training programme in Singapore.

RESULTSThe overall response rate was 64.1% (82/128 residents). The most frequently cited barrier was lack of time. Only a third of the residents surveyed were actively participating in research. Those with postgraduate qualifications were more likely to be involved in research (odds ratio 4.71, p = 0.015). Among the 82 residents, 40.2% reported an interest in research as part of their career; these were mainly graduates from overseas universities or postgraduates. A belief that research is an intrinsically valuable activity distinguished residents who chose research as a career path from those who were undecided (p = 0.004). The belief that research is a means to better clinical practice also divided those who chose research from those who rejected it (p = 0.02).

CONCLUSIONOur findings suggest that specific beliefs determine the level of research activity and career interest among residents. Novel strategies may be incorporated in training programmes to improve the interest and participation of residents in research, and to facilitate the development of academic clinicians.