2009

Ng KH
Correspondence: Prof Ng Kwan Hoong, dwlng@tm.net.my

ABSTRACT
Publishing is a hallmark of good scientific research. The aim of publishing is to disseminate new research knowledge and findings as widely as possible in a timely and efficient manner. Scientific publishing has evolved over the years with the advent of new technologies and demands. This paper presents a brief discussion on the evolution and status of electronic publishing. The Open Access Initiative was created with the aim of overcoming various limitations faced by traditional publishing access models. Innovations have opened up possibilities for electronic publishing to increase the accessibility, visibility, interactivity and usability of research. A glimpse of the future publishing landscape has revealed that scientific communication and research will not remain the same. The internet and advances in information technology will have an impact on the research landscape, scholarly publishing, research policy and funding, dissemination of knowledge, and the progress of science as a whole.

Keywords: biomedical science, electronic journal, electronic publishing, online publishing, open access, scholarly publishing
Singapore Med J 2009; 50(3): 230-234

Loukas M, Noordeh N, Tubbs RS, Jordan R
Correspondence: Dr Marios Loukas, edsg2000@yahoo.com

ABSTRACT
Axillary arch muscles have been described as having variable and sometimes multiple insertions. We report a 90-year-old female cadaver with an axillary arch muscle that originated from the latissimus dorsi and was inserted into the pectoralis major, pectoralis minor and coracoid process. Recognising that axillary arch muscles can be present in such complex forms is important in clinical practice.

Keywords: axillary arch muscle of Langer, coracoid process, latissimus dorsi, pectoralis major muscle, pectoralis minor muscle
Singapore Med J 2009; 50(2): e88-e90

Kanchan T, Shetty M, Nagesh KR, Menezes RG
Correspondence: Dr Tanuj Kanchan, tanujkanchan@yahoo.co.in

ABSTRACT
The identification of skeletal remains is one of the classic problems faced by forensic experts. Congenital and acquired malformations can prove to be an important tool for identification, provided antemortem records are available. A lumbosacral transitional vertebra is one such rare congenital anomaly that has clinical and medicolegal implications. We report a case of unilateral lumbosacral transitional vertebra, detected during medicolegal examination of skeletal remains that were recovered from a forested area in coastal Karnataka, India. The congenital anomaly of the transitional vertebra helped in the forensic identification of the deceased.

Keywords: congenital sacral anomaly, forensic science, lumbosacral vertebra, remains identification, transitional vertebra
Singapore Med J 2009; 50(2): e85-e87

Hocaoglu C
Correspondence: Dr Cicek Hocaoglu, chocaoglu@superonline.com

ABSTRACT
A suicide pact is an agreement between two or more people to kill themselves. They represent 0.6–4.0 percent of all suicides, with the vast majority being double suicides. Double suicides are quite rare and are generally seen in old, married couples. We present a double suicide pact involving two young brothers aged 20 and 22 years. Using these two detailed cases and other cases reported in the literature, some general observations on the psychodynamics of suicide pacts are discussed. This is the first study in the literature on a suicide pact made by two brothers.

Keywords: double suicides, suicide attempt, suicide pacts
Singapore Med J 2009; 50(2): e81-e84

Arora M, Praharaj SK, Sinha VK, Sarkar S
Correspondence: Dr Manu Arora, drmanu2004@rediffmail.com

ABSTRACT
A 55-year-old man with congenital hemiparesis of the right side, three episodes of generalised tonic-clonic seizure at 16 years of age, and two episodes of severe depression and two episodes of hypomania in the past, presented with severe depression with psychotic symptoms. Computed tomography of the brain showed a grey matter-lined cerebrospinal fluid-filled cleft in the left cerebral hemisphere, involving the temporoparietal region. He was diagnosed to have bipolar II disorder, and was currently severely depressed with psychotic symptoms and schizencephaly. He improved with sodium valproate 1,000 mg/day, quetiapine 450 mg/day and escitalopram 20 mg/day after three weeks without any emergent side effects, and was maintaining well at three months follow-up. Although uncommon, schizencephaly may be considered as one of the differentials in cases of bipolar disorder along with congenital hemiparesis, mental retardation and/or seizures; and neuroimaging should be done to confirm the diagnosis.

Keywords: bipolar II disorder, depression, hemiparesis, schizencephaly, seizure
Singapore Med J 2009; 50(2): e79-e80

Oteh M, Azarisman SMS, Hanim NMA, Noorfaizan S
Correspondence: Dr Azarisman Shah Mohd Shah

ABSTRACT
Congenital coronary artery anomalies are rare, with an incidence of about 0.06–1.3 percent of all patients undergoing cardiac catheterisation. They are commonly asymptomatic, but potentially serious lesions may lead to myocardial ischaemia, infarction and/or sudden cardiac death. The occurrence of a concomitant stenotic lesion is exceedingly rare. We report an 80-year-old man who presented with acute anterior myocardial infarction. Coronary angiography revealed severe proximal left anterior descending (LAD) and arteriovenous malformation (AVM) from the first septal branch of the LAD. The LAD stenosis and the AVM were successfully treated with two Jomed^® covered stents.

Keywords: acute anterior myocardial infarction, arteriovenous malformation, congenital coronary artery anomalies, left anterior descending artery, myocardial infarct
Singapore Med J 2009; 50(2): e76-e78

Kumar S, Jain AP, Jain S
Correspondence: Dr Sunil Kumar, drsunilkr_med@rediffmail.com

ABSTRACT
Epistaxis is a frequent presentation in the emergency department and often causes significant anxiety among patients and their relatives. We report a 30-year-old man with mitral stenosis presenting with epistaxis as the initial symptom. He had no other symptoms related to mitral stenosis prior to this episode. Epistaxis is a very unusual initial presentation of rheumatic mitral stenosis.

Keywords: mitral stenosis, epistaxis, rheumatic heart disease
Singapore Med J 2009; 50(2): e74-e75

Jebasingh KF, Koshy TG, Paul TV, Paul MJ, Abraham D, Viswabandya A
Correspondence: Dr K Felix Jebasingh, felixjebasingh@msn.com

ABSTRACT
We report pheochromocytoma and haemophilia occurring in a 19-year-old South Indian man. To the best of our knowledge, this case is the first of its kind to be reported in the medical literature. The patient had bilateral adrenal pheochromocytomas with an extradrenal pheochromocytoma on the left side, and was successfully operated on after optimal preoperative blood pressure control and factor VIII support.

Keywords: bilateral adrenalectomy, factor VIII concentrate, haemophilia, pheochromocytoma
Singapore Med J 2009; 50(2): e71-e73

John M, Menon SK, Shah NS, Menon P
Correspondence: Dr Mathew John, drmathewjohn@yahoo.com

ABSTRACT
This series describes two patients with congenital adrenal hyperplasia due to 11ß-hydroxylase deficiency. The first patient, a ten-year-old with XX genotype, reared as a male, presented with resistant hypokalaemia and hypertension. The second patient, a 23-year-old with XY genotype, presented with bilateral adrenal masses and resistant hypertension. Both the patients were offered bilateral adrenalectomy. These two patients are described with a discussion on the role of bilateral adrenalectomy in the management of difficult cases of congenital adrenal hyperplasia. The association of myelolipoma and testicular rests with this condition is also discussed.

Keywords: 11ß-hydroxylase deficiency, adrenal hyperplasia, adrenalectomy, congenital adrenal hyperplasia, myelolipoma, resistant hypertension, testicular rests
Singapore Med J 2009; 50(2): e68-e70