Aged ; Burkitt Lymphoma ; complications ; pathology ; Humans ; Intestinal Perforation ; etiology ; Jejunal Diseases ; etiology ; Jejunal Neoplasms ; complications ; pathology ; Male

INTRODUCTIONThe present study aimed to assess the immediate/early clinical outcomes and surgical results of 11 consecutive patients who underwent palliative cervical spine surgery for symptomatic spinal metastases.

METHODSThis single-surgeon retrospective case series analysed 12 surgical procedures that were performed for symptomatic cervical spinal metastasis in 11 consecutive patients. All surgeries were carried out at Singapore General Hospital, Singapore, from 2007 to 2013. Preoperative medical oncological assessment/staging was performed on each patient--all patients presented with either axial neck pain or neurological deficits, and had no bladder or bowel symptoms. The primary outcomes analysed were postoperative neurological power and improvement in neck pain.

RESULTSAnterior (n = 5), posterior (n = 4) and combined (n = 2) surgical approaches were used for decompression and stabilisation. Comparing between pre- and postoperative pain scores (scored according to the visual analog scale), and pre- and postoperative limb power scores (scored according to the Medical Research Council scale for muscle strength), we found that all patients showed improvement in their symptoms. Postoperatively, patients had either improvement or preservation of neurological power, and all patients had a decrease in axial neck pain after surgery. Although there was one case of minor pedicle screw instrumentation malplacement, this did not result in any neurological symptoms. Median survival for the patients was 108 (range 7‒1,095) days.

CONCLUSIONPalliative surgery for cervical spine metastasis is safe with good neurological results, low complication rates, and improvement in neck pain. A multidisciplinary approach involving surgeons, medical oncologists and radiotherapists is needed to optimise patient care and outcome.

Adult ; Aged ; Decompression, Surgical ; Female ; Humans ; Male ; Middle Aged ; Palliative Care ; methods ; Retrospective Studies ; Spinal Neoplasms ; secondary ; surgery ; Young Adult

Humans ; Extremities ; Sarcoma/radiotherapy* ; Soft Tissue Neoplasms/radiotherapy* ; Neoplasm Recurrence, Local

INTRODUCTIONThe prevalence of hiatal hernias and para-oesophageal hernias (PEHs) is lower in Asian populations than in Western populations. Progressive herniation can result in giant PEHs, which are associated with significant morbidity. This article presents the experience of an Asian acute care tertiary hospital in the management of giant PEH and parahiatal hernia.

METHODSSurgical records dated between January 2003 and January 2013 from the Department of Surgery, Changi General Hospital, Singapore, were retrospectively reviewed.

RESULTSTen patients underwent surgical repair for giant PEH or parahiatal hernia during the study period. Open surgery was performed for four patients with giant PEH who presented emergently, while elective laparoscopic repair was performed for six patients with either giant PEH or parahiatal hernia (which were preoperatively diagnosed as PEH). Anterior 180° partial fundoplication was performed in eight patients, and mesh reinforcement was used in six patients. The electively repaired patients had minimal or no symptoms during presentation. Gastric volvulus was observed in five patients. There were no cases of mortality. The median follow-up duration was 16.3 months. There were no cases of mesh erosion, complaints of dysphagia or recurrence of PEH in all patients.

CONCLUSIONGiant PEH and parahiatal hernia are underdiagnosed in Asia. Most patients with giant PEH or parahiatal hernia are asymptomatic; they often present emergently or are incidentally diagnosed. Although surgical outcomes are favourable even with a delayed diagnosis, there should be greater emphasis on early diagnosis and elective repair of these hernias.

Adult ; Aged ; Digestive System Surgical Procedures ; methods ; Elective Surgical Procedures ; Female ; Hernia, Hiatal ; diagnostic imaging ; surgery ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Singapore ; Surgical Mesh ; Tertiary Care Centers ; Treatment Outcome

Asian People ; Humans ; Prevalence ; Stereotyping

Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.