Ministry of health clinical practice guidelines: cancer screening.

The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with key recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on cancer screening, for the information of readers of the Singapore Medical Journal. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov. sg/mohcorp/publications.aspx?id=24018). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Control of pain during transrectal ultrasound-guided prostate biopsy: a prospective study comparing two methods.

AIM: To evaluate the efficacy of intramuscular injection of 75 mg diclofenac sodium and periprostatic nerve block (PPNB) with 1% lignocaine in controlling pain during transrectal ultrasound (TRUS)-guided prostate biopsy. MATERIALS AND METHODS: A total of 120 patients undergoing TRUS-guided prostate biopsies were prospectively enrolled in the study. First, 20 patients did not get any form of analgesia/anesthesia and served as control; next, 20 patients received an intramuscular injection of diclofenac sodium. PPNB with 1% lignocaine was performed in the remaining 80 patients. Pain was assessed using Wong-Baker Faces Pain-Rating Scale (0-10). RESULTS: All three groups of patients were comparable at baseline in terms of age, prostate-specific antigen and final histological diagnosis. The mean pain scores (+/-SD) for control, diclofenac and PPNB groups were 5.10 +/- 3.14, 3.70 +/- 2.36 and 2.24 +/- 1.63, respectively. The difference was statistically significant between control and PPNB (p = 0.001), and diclofenac and PPNB (p = 0.002), but not between the control and diclofenac group (p = 0.120). In addition, the proportion of patients having mild or no pain (defined as pain score

Seminal vesicle calculus after transurethral resection of ejaculatory duct.

We report a case of symptomatic seminal vesicle calculus following transurethral resection of ejaculatory duct. A 37-year-old male, who had previously undergone transurethral resection of ejaculatory duct, presented with perineal discomfort and graveluria. Computed tomography revealed a calculus situated within a dilated left seminal vesicle. The patient was treated with cystoscopy and litholapaxy of the seminal vesicle calculus. Although rare, our case demonstrates that seminal vesicle calculi formation can occur following treatment of ejaculatory duct obstruction, possibly secondary to urinary reflux and stasis.

Surgical complications of Tenckhoff catheters used in continuous ambulatory peritoneal dialysis.

INTRODUCTION: The objective of this study was to audit the early and late complications of open Tenckhoff catheter insertion under local anaesthesia in a single institution. METHODS: A review was carried out on 164 insertions in 139 patients over a three-year period. All patient records were retrospectively analysed until the time of transfer to haemodialysis, death, or to current time if alive and receiving continuous ambulatory peritoneal dialysis (CAPD). Patient characteristics, operative factors, early and late complications were recorded. RESULTS: Early complications were reported in 31 percent of catheter insertions, predominantly wound infections and catheter malfunctions. The factors that were significantly associated with early complications were diabetes mellitus, glomerulonephritis, ongoing sepsis, previous abdominal surgery and prolonged surgical time. Late complications were seen in 26 percent of catheter insertions, mainly CAPD peritonitis. Poor nutritional status had a significant negative impact on late complications. The overall median catheter survival time was 41.9 months (95 percent confidence interval, 25.8-58.0 months). In addition, no significant difference in catheter survival time was detected between those patients with and those without diabetes mellitus. CONCLUSION: Tenckhoff catheter insertion for CAPD is a procedure associated with significant surgical morbidity. Patients with diabetes mellitus, glomerulonephritis and ongoing sepsis are at greater risk of early complications, and hence, must have their conditions stabilised or treated before surgery. In addition, prolonged surgical time and patients with previous abdominal surgery are at increased risk. The rate of complications may be improved by early consideration of patients with poor tolerance of local anaesthetic surgery or with previous abdominal surgery for laparoscopic insertion under general anaesthesia. To prevent late complications dominated by CAPD peritonitis, patients' nutritional status and care of the catheter should both be optimised.

A case of localised ureteric amyloidosis.

We describe a case of localised amyloidosis of the distal ureter in a 66-year-old lady who presented with intermittent haematuria. Ureteric transitional cell carcinoma was strongly suspected from the clinical and radiological features, and subsequent nephroureterectomy was performed. Histology revealed nodular eosinophilic deposits in the ureteric wall, with the staining characteristics of amyloid. The literature is reviewed, and conservative surgery is advocated, based on a greater awareness together with improved intraoperative diagnosis of this rare lesion.