2009

Ching BC, Wong JSL, Tan MH, Jara-lazaro AR
Correspondence: Dr Ching Boon Chye, riqq@hotmail.com

ABSTRACT
Intraosseous haemangioma constitutes less than ten percent of all primary bone neoplasms. Approximately 75 percent occur in the calvarium or vertebrae, with long bones, short tubular bones and ribs constituting the rest. We describe a 52-year-old woman who presented with left knee pain for 4–5 years and loss of weight over one week. An initial radiograph of the knee showed several well circumscribed isodense lesions with sclerotic rims in the medullary cavity of the distal femur and diaphysis of the left tibia. There were also lucent lesions with a slightly sclerotic rim in the diaphysis of the left tibia and proximal left fibula. In view of the clinical presentation and radiological findings, extensive investigations were made to rule out metastases and multiple myeloma. An open biopsy with segmental osteotomy of the left mid fibular lesion revealed an intraosseous haemangioma.

Keywords: bone haemangioma, intraosseous haemangioma, skeletal angiomatosis, vascular malformation, vascular anomaly
Singapore Med J 2009; 50(5): e195-e198

Pillai BP, Chong VH, Yong AML
Correspondence: Dr Vui Heng Chong, chongvuih@yahoo.co.uk

ABSTRACT
Purple urine bag syndrome is a rare disorder where the plastic urinary catheter bag and tubing turn purple. The discolouration is due to the presence of indigo and indirubin pigments which are metabolites of tryptophan. It is associated with urinary tract infection. Bacteria that produce sulphatase and phosphatase are involved in the formation of these pigments. Purple urine bag syndrome is associated with higher morbidity and mortality, compared to urinary tract infection without this phenomenon. We present a case report of this rare phenomenon occurring in a 68-year-old woman.

Keywords: chronic urinary catheterisation, indigo pigment, indirubin pigment, purple bag syndrome, urinary tract infection
Singapore Med J 2009; 50(5): e193-e194

Singh VK, Shah G, Singh PK, Saran D
Correspondence: Mr Vinay K Singh, we.publish@googlemail.com

ABSTRACT
Hoffa’s disease is an obscure cause of anterior knee pain. A misconception about its rarity is very common among clinicians, and hence it is often misdiagnosed and treated as meniscal pathology. Increased awareness is required to diagnose and treat the condition appropriately. These diagnostic uncertainties commonly result in increased patient morbidity and mismanagement. In spite of a widely-accepted common occurrence of Hoffa’s disease, ossification of the Hoffa’s fat pad is seldom reported. We report a giant extraskeletal ossifying chondroma in a 55-year-old man, presented as chronic knee pain and successfully treated by excision. The anatomy, pathology, histology, radiological features and management of the disease are described, to increase awareness in the orthopaedic community of this common, interesting but rarely discussed condition.

Keywords: chondroma, extraskeletal chondroma, Hoffa’s disease, infrapatellar fat pad
Singapore Med J 2009; 50(5): e189-e192

Ong CWM, Chua LS, Ng A, Low SY
Correspondence: Dr Catherine WM Ong, catongwm@yahoo.com

ABSTRACT
Langerhans cell histiocytosis (LCH) is a rare disease characterised by monoclonal proliferation and infiltration of organs by large mononuclear cells. Organs commonly involved include the lungs and pituitary gland. However, the disease association with hypogonadotrophic hypogonadism has not been reported in the literature, to our knowledge. We report a 26-year-old Chinese man with LCH, recurrent pneumothoraces, diabetes insipidus and hypogonadotrophic hypogonadism. The clinical features and management of the disease are reviewed.

Keywords: diabetes insipidus, hypogonadotrophic hypogonadism, interstitial lung disease, Langerhans cell histiocytosis
Singapore Med J 2009; 50(5): e185-e188

Teoh XH, Tan TYT, Chow KK, Lee IW
Correspondence: Dr Tony Tan, tan_tony@rafflesmedical.com

ABSTRACT
Cri-du-chat syndrome is a chromosomal abnormality involving a 5p deletion and is characterised by a cat-like cry, mental retardation, microcephaly and abnormal facial features. We report a case of prenatally-diagnosed cri-du-chat syndrome. Although PAPP-A was low at first trimester screening (FTS), the combined risks of trisomies 21, 18 and 13 were low. Amniocentesis was, however, carried out following the ultrasonographical observation of a severely hypoplastic nasal bone, cerebellar hypoplasia, choroid plexus cyst and a single umbilical artery during the second trimester. This case report highlights the importance of careful examination of basic and extended foetal biometry and structures, as well as soft markers for the detection of rarer chromosomal abnormalities that may be missed at FTS.

Keywords: antenatal ultrasonography, cerebellar hypoplasia, cri-du-chat syndrome, first trimester screening, hypoplastic nasal bone, pregnancy-associated plasma protein A, prenatal diagnosis
Singapore Med J 2009; 50(5): e181-e184

Lim HY, Agarwal AM, Agarwal N, Ward JH
Correspondence: Dr John H Ward, john.ward@hci.utah.edu

ABSTRACT
Prostate cancer is a common cancer, especially among elderly men. It is sometimes not diagnosed until it has metastasised. Disseminated intravascular coagulopathy (DIC) can be the presenting manifestation of prostate cancer, and can present with bleeding (varying from isolated epistaxis to generalised haemorrhage), intravascular thrombosis, or both. A case of recurrent epistaxis from DIC due to metastatic prostate cancer occurring in an 84-year-old Caucasian man is presented, and the pathophysiology and management of DIC in association with androgen-sensitive prostate cancer are discussed.

Keywords: androgen-sensitive prostate cancer, disseminated intravascular coagulation, epistaxis, metastatic prostate cancer, prostate cancer
Singapore Med J 2009; 50(5): e178-e180

Anand KS, Dhikav V
Correspondence: Prof Kuljeet S Anand, kuljeet_anand@rediffmail.com

ABSTRACT
A rare case of primary headache associated with sexual activity in a 40-year-old married Indian man who had coital and postcoital headaches responsive to indomethacin is reported.

Keywords: coital headache, postcoital headache, sex-related headache, sexual activity-associated headache
Singapore Med J 2009; 50(5): e176-e177

Liow MHL, Chong SJ, Kang WL
Correspondence: Dr Liow M H Lincoln, lenenkie@gmail.com

ABSTRACT
Decompression sickness (DCS) is manifested in a myriad of symptoms, and can affect any part of the body. It is attributed to the formation of inert gas bubbles in the blood and tissues. Following a diving incident, the pathogenesis of DCS is a result of mechanical obstruction caused by the inert gas bubbles and the body’s immunological response to the bubbles. Neurological DCS may present with unusual sensory/motor symptoms that may lead to paralysis. This report describes three divers who suffered severe neurological Type II DCS and underwent recompression therapy at the Naval Hyperbaric Centre in 2007.

Keywords: decompression sickness, diving complication, hyperbaric oxygenation, neurological deficits, recompression therapy
Singapore Med J 2009; 50(5): e173-e175

Kumar S, Tiwary SK, Khanna AK
Correspondence: Prof Ajay K Khanna, akhannabhu@gmail.com

ABSTRACT
An accessory tongue is a rare anomaly. In the literature, only a few case reports have been cited. We report a 28-year-man with this anomaly. The patient was treated with a simple surgical excision.

Keywords: accessory tongue, double tongue, tongue anomaly
Singapore Med J 2009; 50(5): e172