Imperforate hymen: cause of lower abdominal pain in teenage girls

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Singapore Med J 2009; 50(11): e378-e379
Imperforate hymen: cause of lower abdominal pain in teenage girls

Mou JWC, Tang PMY, Chan KW, Tam YH, Lee KH 
Correspondence: Dr Jennifer Wai Cheung Mou, jennifermou@surgery.cuhk.edu.hk 

ABSTRACT 
Imperforate hymen is a relatively rare congenital anomaly. However, it is not an uncommon cause of lower abdominal pain presenting in teenage girls. Without careful history taking and thorough examination, the condition can be missed easily. We report an imperforate hymen presenting as abdominal pain in three teenage girls aged 12, 12 and 13 years, respectively, within a six-month period. The presentation was reviewed and the various types of hymenotomy were discussed. 

Keywords: adolescents, abdominal pain, haematocolpos, hymenotomy, imperforate hymen 
Singapore Med J 2009; 50(11): e378-e379

Multiple epidermal cysts occcurring in a tattoo

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Singapore Med J 2009; 50(11): e376-e377
Multiple epidermal cysts occcurring in a tattoo

Koh MJA, Teo RYL, Liu TT
Correspondence: Dr Mark Jean Aan Koh, mark_koh@cgh.com.sg 

ABSTRACT
In decorative tattooing, pigment is introduced into the skin with needles or a tattoo gun to create a picture, motif or symbol. Various skin reactions have been reported in association with tattoos. These include acute inflammatory reactions, eczematous hypersensitivity reactions, pseudolymphomatous reactions and skin infections. We present a 24-year-old Malay man who developed multiple epidermal cysts a month after tattooing. To the best of our knowledge, this is the first case in the literature of epidermal cysts occurring after skin tattooing. 

Keywords: epidermal cyst, milia, skin reaction, tattoo 
Singapore Med J 2009; 50(11): e376-e377

Frontal mucocoele secondary to nasal polyposis: an unusual complication

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Singapore Med J 2009; 50(11): e374-e375
Frontal mucocoele secondary to nasal polyposis: an unusual complication

Chew YK, Noorizan Y, Khir A, Brito-Mutunayagam S, Prepageran N
Correspondence: Dr Chew Yok Kuan, chewyokkuan@gmail.com

ABSTRACT
The incidence of mucocoeles associated with a non-surgically treated nasal polyposis is rare. We report a rare case of nasal polyposis with asymptomatic frontal mucocoeles in a 28-year-old Malay man who presented with bilateral nasal obstruction with anosmia. Physical examination revealed bilateral grade III nasal polyps causing obstruction. Computed tomography revealed paranasal polyposis with a large polyp extending and expanding the posterior table of the frontal sinus causing erosion and thinning of its wall. Marsupialisation of the mucocoele and nasal polypectomy were done. Endoscopic sinus surgery and marsupialisation should be the treatment of choice for asymptomatic frontal mucocoele.

Keywords: frontal mucocoele, mucocoele marsupialisation, nasal polyposis
Singapore Med J 2009; 50(11): e374-e375

Granulomatous meningitis

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Singapore Med J 2009; 50(11): e371-e373
Granulomatous meningitis

Loy ST, Tan CWT
Correspondence: Dr Clement Tan, clement_wt_ tan@nuh.com.sg

ABSTRACT 
We report idiopathic hypertrophic pachymeningitis in a previously-healthy 34-yearold Filipino man, who presented with third and sixth cranial nerve palsies, headache, vomiting and left proptosis. Magnetic resonance imaging of the brain showed diffuse dural thickening and enhancement, with mild cerebrospinal fluid lymphocytosis and slight protein elevation. The patient was treated with anti-tuberculous medications and steroids, and made good recovery. We discuss the differential diagnoses and various diagnostic tests with respect to granulomatous inflammation of the meninges. 

Keywords: granulomatous lesions, idiopathic hypertrophic pachymeningitis, meningeal inflammation, pachymeningitis, sarcoidosis,  tuberculosis
Singapore Med J 2009; 50(11): e371-e373

Minimally-responsive head injury survivors may have chronic catatonia reversed years after an accident

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Singapore Med J 2009; 50(11): 1117-1118
Minimally-responsive head injury survivors may have chronic catatonia reversed years after an accident

Clinics in diagnostic imaging (129)

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Singapore Med J 2009; 50(11): 1102-1109
Clinics in diagnostic imaging (129)

See PPL, Peh WCG, Wong LY, Chew KTL
Correspondence: Prof Wilfred CG Peh, wilfred.peh@gmail.com


ABSTRACT
Ganglion cysts arising from the posterior cruciate ligament (PCL) of the knee are rare. We describe a 21-year-old Chinese woman who presented with right knee pain following a twisting injury six months prior. Her pain was exacerbated by squatting, although her range of knee motion was full. Magnetic resonance imaging showed a lobulated, well-defined, T1-hypointense and T2- hyperintense, septated cystic mass arising from the posterior aspect of the PCL. The diagnosis of a PCL ganglion cyst was confirmed by computed tomography-guided aspiration of the cyst. Due to persistent mild knee pain, the patient eventually underwent arthroscopic decompression of the ganglion cyst. The clinical features, diagnosis and management of PCL ganglion cysts are discussed.

Keywords: cruciate ligament, ganglion cyst, knee cystic masses, posterior cruciate ligament
Singapore Med J 2009; 50(11): 1102-1109