2009

Sim HL, Seah M, Tan SM
Correspondence: Dr Tan Su-Ming, su_ming_tan@cgh.com.sg

ABSTRACT
Introduction The incidence of breast cancer in Asia is rapidly rising. Knowledge and perception often influence attendance at screening programmes. However, there has not been any survey to assess the level of knowledge of breast cancer in an Asian population. Singapore has a multiracial population and is the only Asian country with a national screening programme. We conducted a survey on 1,000 women to assess their level of knowledge and screening practices.
Methods A self-administered questionnaire was used, where one point was given for a correct answer and zero for an incorrect / “not sure” response. The maximum knowledge score was 19. The women were also surveyed for their screening practices. Points were not assigned to questions on practice.
Results The response rate was 100 percent. The mean score was 11.4 and the median was 12 (range 0–19). The scores were high for general knowledge and disease progression, but poor for risk factors, screening, symptoms and treatment. Several myths and misconceptions were prevalent. Only 53 percent did regular breast self-examination (BSE), while 57 percent of women aged 40 years and above had gone for a screening mammogram. Increasing age, Malay race, lower educational level, lower socioeconomic class and not knowing anyone with breast cancer were significant independent predictors of poor knowledge. Higher educational level and knowledge scores were significant independent predictors of BSE practice and screening mammogram attendance.
Conclusion Knowledge affects practice. Public education is required to correct misconceptions and focus on women with poor knowledge. This would help to improve screening attendance rates.

Keywords: breast cancer knowledge, breast self examination, public education, screening mammogram
Singapore Med J 2009; 50(2): 132-138

Cheng CL, Saw SM, Pang CE, Chee C
Correspondence: Dr Bobby CL Cheng, bobby_cheng@snec.com.sg

ABSTRACT
Introduction This study aimed to describe the morphology of age-related macular degeneration (AMD) as well as to obtain an estimate of the population-based incidence rate in Singapore.
Methods This is a retrospective hospital-based study of AMD cases seen in 1991 and 1992 at the Singapore National Eye Centre (SNEC), a tertiary eye centre. All case notes recorded with the International Classification of Diseases, ninth revision, clinical modification code ‘362.5’, which is ‘degenerations of the macula’, were retrieved and analysed. Only case notes of patients who were aged 50 years and above and with documented AMD were included in the study.
Results There were 41 (21.8 percent) patients with drusen alone, 39 (20.7 percent) with dry AMD and 108 (57.5 percent) with exudative AMD. The morphology of the disease was similar among the Chinese and non-Chinese and there were no gender differences. A significant majority of patients with dry and exudative AMD had legal blindness at presentation (p-value is less than 0.0001). Notably, 27 (33.3 percent) patients with exudative AMD had improved vision with time. In comparison, the majority of patients with dry AMD or drusen alone tended to have the same or worsening visual acuity over time. The two-year SNEC hospital incidence rate of AMD in 1991–1992 was 0.38 percent or equivalent to 3.8 per 1,000 new cases seen at SNEC. The estimated population-based incidence rate of exudative AMD was 0.02 percent.
Conclusion The population incidence of exudative AMD is lower but comparable to the Western population. Patients with exudative AMD tend to have poorer vision as compared to patients with geographical atrophy or drusen. The proportion of exudative AMD to geographical atrophy appears to be higher than in the West.

Keywords: age-related macular degeneration, drusen, dry age-related macular degeneration, exudative age-related macular degeneration, macular degeneration
Singapore Med J 2009; 50(2): 126-131

Lim LH, Lee SY, Ang CL
Correspondence: Dr Ang Chong Lye, ang.chong.lye@snec.com.sg

ABSTRACT
Introduction This study aims to evaluate the factors affecting the accuracy of biometry assessment using the SRK II formula in predicting the refractive outcome after uneventful cataract surgery by phacoemulsification for eyes within the normal range of axial lengths.
Methods A retrospective review of 100 consecutive cases of uncomplicated phacoemulsification surgery performed by two surgeons from January to September 2005 in a single centre was done. Eyes with axial length greater than or equal to 22.5 mm and less than 24.5 mm were included in the study. The error of prediction was calculated by actual postoperative refractive error minus the refraction target. A comparison was made between the low predictability (prediction error more than 0.50 dioptres [D]) and high predictability (prediction error less than or equal to 0.50 D) groups of eyes. Statistical analysis was performed.
Results A total of 267 case notes were reviewed, of which 100 met the inclusion criteria. The mean age was 68.3 years, with a mean keratometric reading of 43.94 +/- 1.27 D and mean axial length of 23.38 +/- 0.51 mm. The mean IOL power used was 21.77 +/- 1.50 D. The mean error was +0.25 +/- 0.67 (range -1.58 to +1.80)D, with the standard error of mean 0.669. 45 percent of the patients were within 0.5 D of the predicted refractive error and 83 percent were within 1.0 D. There was no difference in preoperative corneal astigmatism, mean keratometry, axial length, age or gender of the patient, laterality of the operated eye and intraocular lens power between the low and high predictability groups. There was a negative correlation between the axial length and prediction error.
Conclusion SRK II is reliable in the prediction of the refractive outcome in normal axial length eyes. The findings in our study are comparable to those found in previous studies. We found a negative correlation between axial length and prediction error, even within the range of normal axial length eyes.

Keywords: biometry, cataract surgery, eye axial length, phacoemulsification surgery, SRK II formula, target refraction
Singapore Med J 2009; 50(2): 120-125

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

ABSTRACT
Tables are used in scientific papers to present information in a concise and efficient manner. Tables are able to provide information at any desired level of detail and precision. Presenting data in a table rather than as part of the text is also an effective way to reduce the length of the text. This article provides some basic guidelines to assist authors in preparing clear and effective tables for their papers.

Keywords: medical writing, results, scientific paper, tables
Singapore Med J 2009; 50(2): 117-119

Law YM, Quek ST, Tan PH, Wong SLJ
Correspondence: Dr Tan Puay Hoon, tan.puay.hoon@sgh.com.sg

ABSTRACT
Adenoid cystic carcinoma of the breast is a rare neoplasm that constitutes less than one percent of all mammary carcinomas. To date, there have been about 140 cases reported in the literature. It is a rare variant of adenocarcinoma that usually occurs in the salivary glands. In contrast to the aggressive nature of adenoid cystic carcinoma that occurs in the head and neck region, adenoid cystic carcinoma of the breast has a very favourable prognosis. Little has been published to date on its radiological features. We describe a 63-year-old woman with adenoid cystic carcinoma detected on mammography in our national breast screening programme, the radiological findings at presentation, the surgical management and a review of the literature.

Keywords: adenoid cystic carcinoma, breast adenoid cystic carcinoma, breast tumour, mammography
Singapore Med J 2009; 50(1): e8-e11

Tang PH, Cohen PA
Correspondence: Dr Tang Phua Hwee, phuahwee@yahoo.com

ABSTRACT
Primary neuroblastoma of the mandible is rare with only seven cases reported to date. The diagnosis is made after any possible primary tumour has been adequately investigated for and excluded. We report a one-year nine-month old girl with a primary neuroblastoma of the mandible and discuss its possible aetiology.

Keywords: mandible, mandibular neuroblastoma, paediatric tumour, primary neuroblastoma
Singapore Med J 2009; 50(1): e5-e7

Sabri R, Yasin Y
Correspondence: Dr Reehan Sabri, reehansabri@hotmail.com

ABSTRACT
Charles Bonnet syndrome is a condition usually seen in the visually-impaired elderly, causing complex visual hallucinations in the absence of any delirium, dementia or psychiatric illness. We report an elderly man, with blindness in one eye and a cataract in the other, from the Iban tribe, which is indigenous to the island of Borneo. He presented with a three-week history of vivid hallucinations of burglars intruding on his living quarters in the longhouse where he lived.

Keywords: cataract, Charles Bonnet syndrome, visual hallucinations, visual impairment
Singapore Med J 2009; 50(1): e48-e49

Wee JLH, Sathappan SS, Yeo MSW, Low YP
Correspondence: Dr Sathappan Sathappan, sathappan@ttsh.com.sg

ABSTRACT
Gamma nail breakage is an uncommon occurrence that often arises from fatigue failure of the implant, with a reported incidence ranging from 0.2 to 5.7 percent. We report a 73-year-old woman with a three-part intertrochanteric fracture and who presented two years postoperatively with gamma nail failure secondary to fracture non-union. This patient underwent a revision long-stem bipolar hemi-arthroplasty and has been followed-up for 24 months, with good functional and radiological results.

Keywords: bipolar hemi-arthroplasty, gamma nail, hip implant, implant failure, intertrochanteric fracture
Singapore Med J 2009; 50(1): e44-e47

Sinha N, Gupta N, Jhamb R
Correspondence: Dr Nitin Sinha, drnitinsinha26@yahoo.co.in

ABSTRACT
We present a 14-year-old boy, a known case of idiopathic thrombocytopenic purpura (ITP) for five years, and was treated with intermittent oral steroids. He presented with left upper abdominal pain of three months’ duration. The pain was dull, aching and non-radiating. There were no other associated features. Before this presentation, he was receiving oral steroids for a month. The patient had been hospitalised in the past for ITP-related bleeding. The patient was managed with anti-tuberculous therapy alone, and after nine months, his splenic abscess regressed significantly in size. Tuberculous splenic abscesses are rare, and in particular, isolated tuberculous splenic abscesses are extremely rare with only three cases reported to date. This may be the first case report of tuberculous splenic abscess in ITP. It is noteworthy that this abscess was minimally symptomatic, with no fever or constitutional symptoms.

Keywords: idiopathic thrombocytopenic purpura, tuberculosis, tuberculous splenic abscess
Singapore Med J 2009; 50(1): e41-e43