INTRODUCTIONRadiation injury resulting in sudden, late onset sensorineural hearing loss is a recognised complication in patients who have received head and neck irradiation. We describe the magnetic resonance imaging (MRI) of the internal acoustic canal (IAC) of 3 such patients and postulate a cause for these findings.

CLINICAL PICTUREA total of 63 patients were referred for MRI IAC for sudden-onset sensorineural hearing loss. Of these patients, only 5 patients had abnormal MRI finding in the affected ear and the remaining patients had normal studies. Two patients had acoustic neuromas. Three patients demonstrated high T1-weighted signal in the labyrinths of the affected ears and had past histories of head and neck irradiation. The MRI findings and medical records of these 3 patients were reviewed and described in this case series.

OUTCOMEHigh labyrinthine signal on unenhanced T1-weighted images in the symptomatic ear of these patients was observed, suggesting the possibility of haemorrhage. In the patient who had a history of brain tumour, susceptibility artifacts were also seen in the right hemipons on the gradient-echo images, indicating the presence of paramagnetic substances from previous therapy.

CONCLUSIONWe postulate that labyrinthine haemorrhage is a rare, late complication of head and neck irradiation, resulting in sudden sensorineural hearing loss.

Female ; Head and Neck Neoplasms ; radiotherapy ; Hearing Loss, Sensorineural ; etiology ; Hearing Loss, Sudden ; etiology ; Hemorrhage ; complications ; Humans ; Labyrinth Diseases ; complications ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiotherapy ; adverse effects ; Radiotherapy Dosage ; Time Factors

Heterotopic ossification (HO) is the aberrant formation of ectopic bone within the soft tissues, of which the aetiology is usually either traumatic or neurogenic. Neurogenic HO is a known but uncommon complication that occurs after a cerebral or spinal insult. The condition may present with a spectrum of symptoms and is often difficult to diagnose clinically. Although different imaging modalities have been used to diagnose HO, clinicians and radiologists may occasionally encounter radiological features of HO that may mimic other disease conditions. We herein report a rare case of neurogenic HO occurring in the non-paretic limb of a patient, and the diagnostic and radiological challenges encountered.
Analgesics ; therapeutic use ; Contrast Media ; chemistry ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Ossification, Heterotopic ; diagnosis ; etiology ; Quality of Life ; Radiographic Image Interpretation, Computer-Assisted ; Stroke ; complications ; Tomography, X-Ray Computed

We present a case series of four patients with Caesarean scar pregnancies (CSPs) managed at our gynaecological unit between October 2008 and May 2009. Three patients were detected while asymptomatic, and were treated with elective intragestational sac methotrexate injections. The last patient had presented following complications from a termination of pregnancy for a CSP that was misdiagnosed as intrauterine. Following treatment, this patient and another developed arteriovenous malformation, which responded to bilateral uterine artery embolisations and gonadotropin releasing hormone (GnRH)-agonist treatment.
Abortion, Induced ; methods ; Adult ; Cesarean Section ; adverse effects ; Cicatrix ; complications ; Female ; Humans ; Magnetic Resonance Imaging ; Pregnancy ; Pregnancy, Ectopic ; diagnosis ; etiology ; therapy ; Treatment Outcome

INTRODUCTIONStudies have suggested that women who present with non-ST-segment elevation myocardial infarction (NSTEMI) may differ in their clinical response to early invasive strategy compared to male patients. We examined the impact of gender difference in NSTEMI patients on outcomes following invasive versus conservative treatment.

MATERIALS AND METHODSPatients enrolled in our national myocardial infarction (MI) registry between January 2000 and September 2005 with diagnosis of NSTEMI were retrospectively analysed. The study endpoint was the occurrence of major adverse cardiac events (MACE) in the patients at 1 year.

RESULTSA total of 1353 patients (62.2% male) with NSTEMI were studied. The mean age of men was 62 +/- 14 versus 72 +/- 12 years in women in the cohort (P <0.001). The prevalence of hypertension and diabetes mellitus were significantly higher in women. Men were more likely to undergo revascularisation than women (OR, 2.97; 95% CI, 2.18-3.89, P <0.001). Among those who were revascularised, there was no gender difference in survival or recurrent MI rates during hospitalisation and at 1 year. Compared to medical therapy, percutaneous coronary intervention (PCI) was associated with a significant reduction in MACE in both women (OR, 0.44; 95% CI, 0.20-0.95) and men (OR, 0.40; 95% CI, 4.79-12.75). The most important predictor of MACE for females was diabetes mellitus (HR, 1.98; 95% CI, 1.17-3.33).

CONCLUSIONSThere is a gender-based difference in the rate of revascularisation among patients with NSTEMI. Women benefit from an invasive approach as much as men, despite their advanced age, with similar rates of mortality and recurrent MI at 1-year follow-up.

Adrenergic beta-Antagonists ; therapeutic use ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Myocardial Infarction ; drug therapy ; surgery ; Platelet Aggregation Inhibitors ; therapeutic use ; Practice Patterns, Physicians' ; Recurrence ; Sex Factors ; Survival Analysis

A 68-year-old woman presented with weight loss of 7 kg over two years. Clinical examination revealed no specific abnormality and the patient was otherwise asymptomatic. Chest radiography performed to screen for malignancy revealed a soft tissue opacity projected over the mediastinum. Computed tomography of the thorax showed an enhancing anterior mediastinal mass with heterogeneous enhancement and contrast pooling in the arterial phase, followed by homogeneous enhancement in the venous phase, consistent with an aneurysm arising from the superior vena cava. This case highlights superior vena cava aneurysms as extremely rare causes of anterior mediastinal masses. Other causes of anterior mediastinal masses were also discussed.
Aged ; Aneurysm ; diagnostic imaging ; Female ; Humans ; Mediastinum ; diagnostic imaging ; Radiography, Thoracic ; Tomography, X-Ray Computed ; Vena Cava, Superior ; diagnostic imaging

INTRODUCTIONWe aim to examine the risk predictors of contrast-induced nephropathy (CIN) in patients with normal baseline serum creatinine (Cr). CIN is an important complication postpercutaneous coronary intervention (PCI). Previous studies examined CIN predictors in patients with chronic renal impairment. No large studies investigated patients with normal renal function which constitute the majority undergoing PCI. We aim to identify risk predictors in this cohort and examine the clinical outcomes.

MATERIALS AND METHODSA total of 3036 patients with normal baseline Cr (<1.5 mg/dL) who did not receive prophylaxis while undergoing PCI were enrolled. We examined the occurrence of CIN and the mortality outcome at 1 and 6 months.

RESULTSCIN occurred in 7.3% of patients. The median age was 59.5 years (range, 26 to 86), 78.7% men, 34.6% diabetics. Risk predictors for CIN include age [odds ratio (OR), 6.4; 95% CI, 1.01-13.3; P = 0.042], female gender (OR, 2.0; 95% CI, 1.5-2.7; P = 0.001), abnormal left ventricular ejection fraction (LVEF) <50%(OR,1.02; 95% CI, 1.01-1.04; P = 0.01), anaemia with haemoglobin <11 mg/dL (OR, 1.5; 95% CI, 1.01-2.4; P = 0.044) and systolic hypotension with blood pressure <100 mmHg (OR, 1.5; 95% CI, 1.01-2.2; P = 0.004). Diabetics on insulin therapy were at the highest risk compared with diabetics on oral hypoglycaemics and diet control (18.9% vs 6.8% vs 3.6%; P = 0.001). Patients who developed CIN had higher mortality at 1 month (14.5% vs 1.1%; P <0.001) and 6 months (17.8% vs 2.2%; P <0.001).

CONCLUSIONSSubgroups of patients with normal baseline Cr undergoing PCI are at risk of developing CIN with resultant higher mortality. Age, female gender, insulin dependent diabetes mellitus, presence of hypotension, anaemia and low LVEF are predictors of CIN. Prophylaxis may be considered in these patients.

Adult ; Age Factors ; Aged ; Aged, 80 and over ; Anemia ; Angioplasty, Balloon, Coronary ; adverse effects ; Contrast Media ; adverse effects ; Creatinine ; blood ; Diabetes Mellitus ; drug therapy ; Female ; Glomerular Filtration Rate ; Humans ; Hypotension ; Kidney Diseases ; chemically induced ; Male ; Middle Aged ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Sex Factors ; Survival Analysis ; Ventricular Dysfunction, Left

: One of the most feared complications of childhood cancer treatment is second malignant neoplasms (SMNs). This study evaluates the incidence, risk factors and outcomes of SMNs in a tertiary paediatric oncology centre in Singapore.: A retrospective review was conducted on patients diagnosed with childhood cancer under age 21 and treated at the National University Hospital, Singapore, from January 1990 to 15 April 2012. Case records of patients with SMNs were reviewed.: We identified 1124 cases of childhood cancers with a median follow-up of 3.49 (0 to 24.06) years. The most common primary malignancies were leukaemia (47.1%), central nervous system tumours (11.7%) and lymphoma (9.8%). Fifteen cases developed SMNs, most commonly acute myeloid leukaemia/myelodysplastic syndrome (n = 7). Median interval between the first and second malignancy was 3.41 (0.24 to 18.30) years. Overall 20-year cumulative incidence of SMNs was 5.3% (95% CI, 0.2% to 10.4%). The 15-year cumulative incidence of SMNs following acute lymphoblastic leukaemia was 4.4% (95% CI, 0% to 8.9%), significantly lower than the risk after osteosarcoma of 14.2% (95% CI, 0.7% to 27.7%) within 5 years (<0.0005). Overall 5-year survival for SMNs was lower than that of primary malignancies.: This study identified factors explaining the epidemiology of SMNs described, and found topoisomerase II inhibitor use to be a likely risk factor in our cohort. Modifications have already been made to our existing therapeutic protocols in osteosarcoma treatment. We also recognised the importance of other risk management strategies, including regular long-term surveillance and early intervention for detected SMNs, to improve outcomes of high risk patients.
Bone Neoplasms ; therapy ; Cancer Care Facilities ; Central Nervous System Neoplasms ; therapy ; Follow-Up Studies ; Humans ; Incidence ; Leukemia ; therapy ; Leukemia, Myeloid, Acute ; epidemiology ; Lymphoma ; therapy ; Myelodysplastic Syndromes ; epidemiology ; Neoplasms ; therapy ; Neoplasms, Second Primary ; epidemiology ; Osteosarcoma ; therapy ; Pediatrics ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Survivors ; statistics & numerical data ; Tertiary Care Centers ; Time Factors ; Topoisomerase II Inhibitors ; therapeutic use

Enteral Nutrition ; instrumentation ; methods ; Female ; Fluoroscopy ; methods ; Gastrostomy ; adverse effects ; instrumentation ; methods ; Humans ; Male ; Middle Aged ; Outcome and Process Assessment (Health Care) ; Postoperative Complications ; classification ; diagnosis ; therapy ; Reproducibility of Results ; Retrospective Studies ; Singapore ; Surgery, Computer-Assisted ; methods ; Treatment Outcome

INTRODUCTION: Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7-17 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health. METHODS: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS: Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results. CONCLUSION This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period.
Adolescent ; Child ; Exercise ; Humans ; Public Health ; Sedentary Behavior ; Singapore ; Sleep