A rapidly fatal intracranial anaplastic hemangiopericytoma with de-novo dedifferentiation: emphasis on diagnostic recognition, molecular confirmation and discussion on treatment dilemma.

Solitary fibrous tumors/ hemangiopericytomas (SFT/HPC) are mesenchymal tumors that share a common genetic aberration and very rarely undergo dedifferentiation. We report a unique case of an intracranial anaplastic SFT/HPC with de-novo dedifferentiation, which pursued a rapidly fatal clinical course in a 41-year-old lady. The dedifferentiated component comprised a focal area of glandular formation with epithelial immunophenotype acquisition. The distinct biphasic pattern of the tumor imparted great diagnostic challenges to the pathologists. An increased awareness of SFT/HPCs with a diverse morphologic spectrum or even a biphasic histologic pattern is essential in working up such cases. We first attempted gamma knife radiosurgery in treating a recurrent dedifferentiated SFT/HPC; unfortunately it was to no avail. Although it is now known that SFT/HPC is characterized by NAB2-STAT6 gene fusion, the unavailability of targeted therapy against this molecular signature still results in a treatment dilemma.

Cerebellar strokes: a clinical outcome review of 79 cases.

INTRODUCTION: Cerebellar infarcts and haemorrhages are relatively uncommon, accounting for less than 10% of all strokes. The objective of the present study was to quantify and compare the outcomes of patients with cerebellar infarct and those of patients with cerebellar haemorrhage, as well as to identify the risk factors that predict poor outcome in patients with cerebellar stroke. METHODS: We retrospectively reviewed the medical records of consecutive patients admitted to National University Hospital, Singapore, between 2004 and 2006, within one week of cerebellar stroke onset. Baseline data included demographics, concomitant comorbidities, and the presence or absence of brainstem compression and hydrocephalus (on computed tomography or magnetic resonance imaging). The Glasgow Outcome Scale and modified Rankin Score were used to assess outcome at discharge and at six months after discharge. RESULTS: A total of 79 patients with cerebellar stroke were admitted during the study period. Of these 79 patients, 17.7% died and 31.6% had poor outcomes at six months after discharge. Patients with cerebellar haemorrhage were found to be more likely to have poor outcomes as compared to patients with cerebellar infarct, both at discharge (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.3-14.1) and at six months after discharge (OR 5.2, 95% CI 1.6-17.2). When compared to small lesions (< 5 cm(3)), lesions > 20 cm(3) were significantly associated with poorer outcomes and the development of hydrocephalus and brainstem compression. CONCLUSION: Cerebellar strokes are a significant cause of morbidity and mortality. The outcomes of patients with cerebellar haemorrhage are more likely to be worse than those of patients with cerebellar infarct.

Management of ruptured intracranial aneurysms in the post-ISAT era: outcome of surgical clipping versus endovascular coiling in a Singapore tertiary institution.

INTRODUCTION: The results of the International Subarachnoid Aneurysm Trial (ISAT) in 2002 have significantly influenced the management of ruptured intracranial aneurysms. There is now an established shift worldwide toward endovascular coiling as the initial treatment of choice. We assessed the outcomes of patients admitted to our institution for aneurysmal subarachnoid haemorrhage (SAH), comparing the outcomes of patients (World Federation of Neurosurgical Societies [WFNS] grades 1-3) who underwent surgical clipping versus those who underwent endovascular coiling. METHODS: We retrospectively reviewed patients admitted to the National University Hospital for SAH secondary to ruptured intracranial aneurysm in 2005-2009. Patients were divided into two groups - clipping and coiling. Data on individual demographics, comorbidities, Fisher grading and Glasgow Outcome Scale scores were collected for the two groups and subjected to relevant statistical analyses. RESULTS: Of the 133 patients admitted for nontraumatic SAH, 89 had ruptured aneurysms. Among the 56 patients classified as WFNS grades 1-3, 23 underwent coiling while the remaining 33 underwent clipping. A significant association was found between Fisher grade and the likelihood of developing hydrocephalus in these patients. CONCLUSION: Although we acknowledge the presence of management bias in our institution, our findings were similar to those of the ISAT trial. Upon correlation between our results and current evidence-based findings, our findings show that clipping provides similar long-term outcomes as endovascular coiling. In the event that an aneurysm is deemed unsuitable for coiling, clipping remains an effective option.

Use of Osteoplug polycaprolactone implants as novel burr-hole covers.

INTRODUCTION: The aim of this study was to evaluate the outcome of Osteoplug, a novel biodegradable polymer burr-hole cover implant, used in patients with burr holes done for drainage of chronic subdural haematoma. METHODS: 12 patients with chronic subdural haematoma had Osteoplug implants inserted into their burr holes after evacuation of the haematoma. Osteoplug is a biodegradable polycaprolactone implant with a mushroom-button shape, designed specifically to fit into a 14-mm diameter burr hole. It has an upper rim of 16-mm diameter and a body diameter of 14 mm, with a honeycomb-like architecture of 400-600 mum pore size. The Osteoplug snaps onto the 14-mm diameter burr hole snugly after the evacuation of the liquefied haematoma is done. All 12 patients were followed up for a period ranging from ten months to two years (mean 16 months) postoperatively. They were evaluated for their clinical, radiological and cosmetic outcomes. RESULTS: Osteoplug provided good cosmesis by preventing unsightly depressions over the skull postoperatively in all the 12 patients. Postoperative computed tomography, done at one year, showed signs of good osteointegration into the surrounding calvarial bone, with multifoci mineralisation throughout the scaffold in one patient. There was no case of infection or any adverse systemic reaction noted. Patient satisfaction was high. CONCLUSION: The Osteoplug polycaprolactone burr-hole covers are suitable, biodegradable implants with good medium-term results. They provide an ideal scaffold for osteogenesis and excellent cosmesis. There were no adverse events in all 12 patients, with a mean follow-up of 16 months.

A century of medical students' activities (Medical College Union/Medical Society).

The Medical College Union (MCU) was formed in 1922 to encourage and promote comradeship and public spirit amongst the students of King Edward VII College of Medicine. The Medical College Union Society was founded and held its first meeting on 31 July 1936. However, the Annual Report for 1940-42 made no reference to the Society at all and it was hence considered to cease to exist as an official body. The Medical Society (Medsoc), headed by Mr Goon Sek Mun, was formed in 1949 and it organised various activities and events for the faculty. Some of these are still being held annually today, with the addition of several others and phasing out of some. These were organised by the individual subgroups in the Medical society, like the Social, Welfare, Sports and Publications committees. The Medsoc also acts as the students' voice in conveying their opinions to the administration and the Dean. With the expected advent of a new medical school in Singapore--a postgraduate one in the Outram Campus, the medical student community in Singapore will only get larger. There should be a role for Medsoc to foster closer ties between the student communities.