2009

Dixon AK
Correspondence: Prof Adrian K Dixon, akd15@radiol.cam.ac.uk

ABSTRACT
Clearly, academic endeavour has to be the single most important criterion for appointment to an academic position and for subsequent promotion. It is rare for excellence either in teaching or clinical practice to offset a poor publication record. However, the pressure to publish and gain related grant income can lead to problems in the normal academic pursuits of a department or institution. These and other related issues will be explored in this editorial.

Keywords: academic promotion, citations, impact factor, publication
Singapore Med J 2009; 50(9): 847-850

Basu S, Muthusami S, Kumar A
Correspondence: Dr Sriparna Basu, drsriparnabasu@rediffmail.com

ABSTRACT
A nine-year-old girl presented with pain, unilateral ptosis, inflammation of the upper eyelid and restricted ocular motility. She was diagnosed to have ocular cysticercosis by magnetic resonance imaging of the orbit, which showed a well-defined ring-enhancing lesion in the superior rectus muscle of the left eye. Enzyme-linked immunosorbent assay for serum antibodies against cysticercus was positive. The patient improved dramatically on a therapeutic trial of albendazole and oral steroids. There was a history of spontaneous extrusion of the cyst five days after starting therapy. The conjunctival defect healed without any surgical intervention.

Keywords: eye infection, ocular cysticercosis, ophthalmoplegia, parasitic infection, ptosis, Taenia solium
Singapore Med J 2009; 50(8): e309-e311

Cheng S, Chng SM, Singh R
Correspondence: Dr Shuli Cheng, trudy_cheng@yahoo.com

ABSTRACT
Bilateral venous infarction of the brain due to thrombosis of the deep cerebral venous system is relatively rare, accounting for approximately 3–8 percent of all cases of cerebral venous thrombosis (CVT). Known risk factors include the use of oral contraceptives, pregnancy, puerperium, malignancy and thrombophilic states. CVT, in the setting of acute mountain sickness (AMS), has rarely been reported. We present an unusual occurrence of bilateral deep subcortical venous infarction in a previously-well, 39-year-old woman, who developed AMS during a high altitude expedition in Nepal. The possible mechanisms responsible for this unfortunate event include dehydration with resultant relative polycythaemia and raised intracranial pressure at high altitudes. CVT should be considered in mountain climbers presenting with progressive neurological deterioration that is not solely attributable to AMS.

Keywords: acute mountain sickness, cerebral venous thrombosis, high altitude
Singapore Med J 2009; 50(8): e306-e308

Yim KM, Tse ML, Lau FL
Correspondence: Dr Yim Kin-Ming, anfernee_yim@hotmail.com

ABSTRACT
Chinese medicine plays an important role in providing medical care for people in countries with large Chinese communities, including Hong Kong. The aconite herb is one of the commonly-prescribed ingredients for various clinical problems. However, due to its narrow therapeutic index, toxicities are not uncommonly encountered, including life-threatening cardiac arrhythmias like ventricular arrhythmias. We report a 57-year-old woman with reversible intraventricular conduction defect attributed to the use of processed Fuzi.

Keywords: aconitine poisoning, intraventricular conduction defect, reversible intraventricular conduction defect, processed Fuzi, right bundle branch block
Singapore Med J 2009; 50(8): e302-e305

Lim HC, Poulose V, Tan HH
Correspondence: Dr Tan Hock Heng, hock_heng_tan@cgh.com.sg

ABSTRACT
Ingestional naphthalene mothball poisoning leading to prolonged haemolysis and methaemoglobinaemia can present with diagnostic and therapeutic challenges. A 19-year-old woman ingested 12 mothballs, and presented two days later with haemolysis and methaemoglobinaemia. She was treated with red blood cell transfusions, intravenous methylene blue, N-acetylcysteine and ascorbic acid. Continuous venovenous haemofiltration was conducted for 45 hours. Haemolysis with anaemia and methaemoglobinaemia persisted even after five days post-ingestion. Clinical and biochemical parameters improved. We describe a case of ingestional naphthalene poisoning with a good outcome after treatment.

Keywords: haemolysis, methaemoglobinaemia, mothball ingestion, naphthalene, poisoning
Singapore Med J 2009; 50(8): e298-e301

Falhammar H
Correspondence: Dr Henrik Falhammar, henrik.falhammar@ki.se

ABSTRACT
The measuring of hormones during lactation can result in interpretation difficulties. A 30-year-old woman presented with suspected jaw overgrowth and increased insulin-like growth factor I (IGF-I) (52 nmol/L; reference range 10–40 nmol/L). No other signs of acromegaly were found. She was breastfeeding eight times per day, and when she decreased her breastfeeding to three times per day, IGF-I decreased (41 nmol/L). After the cessation of lactation, IGF-I was normalised (22 nmol/L). No confounding factors which could affect the IGF-I levels, such as nutritional or metabolic factors, were found. Her menstrual cycle was regular all the time. Magnetic resonance imaging of the pituitary gland showed a probably unrelated microadenoma. All other pituitary hormones were normal, indicating that the microadenoma was non-functional. In conclusion, this unique case suggests an association between the frequency of lactation and IGF-I levels, and demonstrates the difficulties encountered when measuring hormones during breastfeeding.

Keywords: acromegaly, insulin-like growth factor I, lactation, pituitary adenoma, prolactin
Singapore Med J 2009; 50(8): e295-e297

Muthukrishnan J, Harikumar KVS, Sangeeta J, Singh MK, Modi K
Correspondence: Dr Jayaraman Muthukrishnan, jmuthukrishnan@hotmail.com

ABSTRACT
Severe muscle weakness in osteomalacia may mimic a primary neuromuscular disorder like spinal muscular atrophy. A 32-year-old woman, initially diagnosed as a case of spinal muscular atrophy based on clinical presentation, electromyography and muscle biopsy, was later found to have osteomalacic myopathy due to primary hyperparathyroidism complicated by vitamin D deficiency. Before diagnosing a progressive, inevitably fatal degenerative condition like spinal muscular atrophy, one must rule out all possible treatable conditions with a similar presentation.

Keywords: primary hyperparathyroidism, myopathy, osteomalacic myopathy, spinal muscular atrophy
Singapore Med J 2009; 50(8): e293-e294

Modi HN, Srinivasalu S, Suh SW, Yang JH
Correspondence: Dr Seung Woo Suh, spine@korea.ac.kr

ABSTRACT
Spondylolisthesis associated with neurofibromatosis is rare, and only 12 cases have been reported so far. However, only one report of grade 4 spondylolisthesis with neurofibromatosis has been reported in the literature. A 15-year-old boy with neurofibromatosis was admitted for back pain and neurological claudication. Radiograph showed grade 4 spondylolisthesis of the L5 vertebra with scalloping of the L4–L5 vertebrae. L4–L5 laminectomy, reduction, L3–S1 posterior instrumentation and fusion were performed. The reduction of the spondylisthesis was done entirely from the posterior approach using pedicle screws. Radiography at four months showed a broken S1 screw with a loss of reduction. The patient was re-operated on, to provide additional stability with pelvic fixation. He was pain-free with a good fusion at the two-year follow-up. Adequate posterior stabilisation with fusion gives good results in grade 4 spondylolisthesis associated with neurofibromatosis and dural ectasia.

Keywords: dural ectasia, grade 4 spondylolisthesis, neurofibromatosis, spondylolisthesis, vertebral scalloping
Singapore Med J 2009; 50(8): e287-e292

Pang HN, Puhaindran M, Yong FC
Correspondence: Dr Fok-Chuan Yong, fok_chuan_yong@ttsh.com.sg

ABSTRACT
We report fibrolipoma involving the median nerve, its palmar cutaneous branch as well as the ulnar nerve in the same hand of a 25-year-old woman. The patient presented with a lump in the wrist with signs of carpal tunnel syndrome. Multiple nerve involvement was detected on magnetic resonance imaging and further confirmed at surgical exploration and decompression. Imaging is recommended in the management of an unusual lump in the wrist.

Keywords: carpal tunnel syndrome, fibrolipoma, fibrolipomatous hamartoma, median nerve, ulnar nerve
Singapore Med J 2009; 50(8): e283-e286

Chakravartty S, Maity K, Ghosh D, Choudhury CR, Das S
Correspondence: Dr Saurav Chakravartty, saurav_tty@yahoo.com

ABSTRACT
Posterior sagittal anorectoplasty (PSARP) is the procedure of choice in cases of anorectal malformation in children. Adult patients can present with anorectal malformation in developing countries. As there is very little data regarding the success of PSARP in cases of adult anorectal malformations, the aim of this study was to perform and assess the effectiveness of PSARP in adults. Two adults (one male, one female) aged 16 and 17 years, respectively, underwent a diverting colostomy followed by a PSARP. The female underwent a posterior vaginal anorectoplasty due to a rectovaginal fistula and is leading a normal life. The male patient had a rectourethral fistula which required meticulous dissection and is now doing well with a Kelly’s score of five. Our experience here suggests that a PSARP provided satisfactory results in adults who present late with an anorectal malformation.

Keywords: adult anorectal malformation treatment,adult posterior sagittal anorectoplasty, anorectal malformation, posterior sagittal anorectoplasty
Singapore Med J 2009; 50(8): e280-e282