Prevalence and correlates of sleep problems among elderly Singaporeans.

BACKGROUND: The current study examined the prevalence and correlates of sleep problems among elderly Singaporeans. METHODS: Data were taken from the Well-being of Singapore Elderly study, a cross-sectional, epidemiological survey conducted among Singapore residents aged 60 years and above (n = 2565). Respondents were screened for sleep problems through a series of questions in the Geriatric Mental State examination. Details on sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression were also collected. Logistic regression analysis was used to explore significant associations between sleep problems, sociodemographic characteristics, physical activity, cognition, disability, chronic physical conditions, and depression. RESULTS: Overall, 13.7% (n = 341) of older adults reported at least one sleep problem. Of those who reported sleep problems, 69.4% experienced sleep interruption at night, 48.9% reported having difficulty falling asleep, 22.3% reported early morning awakening, and 11.4% had all three problems. Elderly with sleep problems were significantly more likely to have a range of chronic physical conditions and depression and were also significantly less likely to be physically active. Older adults with at least one sleep problem reported significantly greater disability compared to those with no sleep problems. CONCLUSION: The high probability of comorbid chronic conditions as well as higher disability among those with sleep problems makes this an important area of research.

Single-port access total laparoscopic hysterectomy for stage 1A1 cancer of the cervix.

We describe the first case of single-port access total laparoscopic hysterectomy with intracorporeal suturing of the vault performed in Singapore. A 40-year-old woman with microinvasive squamous cell carcinoma of the cervix successfully underwent single-port access total laparoscopic hysterectomy. Unique articulated and multifunction laparoscopic instruments were used to complete the surgery in 118 minutes, with no complications. The patient had minimal pain postoperatively and recovered uneventfully within two weeks. This case illustrates the benefits of single-port access laparoscopic surgery in well-selected cases.

Entangled bilateral adnexal torsion in a premenarchal girl: a laparoscopic approach.

Bilateral adnexal torsion is a rare event in children. A high index of suspicion, together with prompt surgical treatment, would help to save the ovaries and preserve its function. We report a case of entangled bilateral adnexal torsion managed successfully via laparoscopy. An 11-year-old premenarchal girl complained of chronic intermittent abdominal pain that worsened over 24 hours. Computed tomography of the abdomen and pelvis showed a bilobed cystic tumour (10 cm × 12 cm × 12 cm and 3 cm × 4 cm) lying in the left abdomen and another cystic tumour (10 cm × 6 cm × 5 cm) in the pelvis. At laparoscopy, entangled bilateral adnexal torsion was seen. After disentanglement and detorsion of both adnexa, bilateral ovarian cystectomy was performed, and both ovaries were preserved. This case illustrates that laparoscopic treatment is possible for large entangled bilateral adnexal torsion in children.

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.

Methotrexate treatment for ectopic pregnancy at the KK Women's and Children's Hospital, Singapore.

INTRODUCTION: Ectopic pregnancy is an acute emergency in the first trimester where surgery is the mainstay of treatment. With the advent of improved diagnostic techniques like high-resolution transvaginal ultrasonography and expedient serum human chorionic gonadotrophin (HCG) assay, ectopic pregnancy is now diagnosed early. At this stage, the conceptus is often small, causing minimal or no symptoms. Medical management may then present an appealing alternative to surgery. Methotrexate has been widely used to treat ectopic pregnancy. A methotrexate ectopic treatment protocol was introduced by the Minimally Invasive Surgery Centre at KK Women's and Children's Hospital, Singapore. We present the results of this treatment. METHODS: A prospective review of 110 cases of medical management of ectopic pregnancy since the implementation of the treatment protocol was undertaken. Demographical data, clinical presentation, treatment progress and outcome were captured using a computer database. All patients were managed as outpatients, and a telephone call-out service was provided to ensure that treatment side effects were monitored and potential treatment failures were identified early. RESULTS: From August 2003 to October 2006, 93 (84.5 percent) patients with ectopic pregnancy were successfully treated with intramuscular methotrexate. 16 patients eventually required surgery and only one patient defaulted on follow-up. There was no major side effect detected in this cohort. The minor side effects reported included mucositis (19.1 percent) and abdominal pain (28.2 percent). CONCLUSION: Methotrexate treatment of ectopic pregnancy is safe. Our treatment protocol enabled us to achieve a reasonable treatment success rate of 84.5 percent.

Nicotine dependence and psychiatric disorders among young males in Singapore.

INTRODUCTION: While the risk for a number of medical illnesses is well established for those who smoke, the risk for psychiatric disorders is not so well studied in Singapore. OBJECTIVES: This study sought to establish the lifetime prevalence of nicotine dependence in a population of young males in Singapore and to establish its relationship with other psychiatric disorders. METHODS: The study was conducted among a cohort of males reporting for their mandatory physical examination prior to their enlistment for National Service in a 1-year period between August 2004 and August 2005. Definitive diagnoses in accordance with DSM-IV criteria were made with the Composite International Diagnostic Interview (CIDI). RESULTS: In the population of 9,702 males assessed by CIDI, the prevalence of nicotine dependence was 12.3%. Academic attainments were significantly poorer in those with nicotine dependence than those without dependence. Nicotine dependence was most strongly associated with delusional disorder and major depressive disorder, which remained even after adjusting for ethnicity and educational attainments (odds ratio [OR] of 59.8 for delusional disorder and OR of 36.3 for major depressive disorder). DISCUSSION: Our study highlights the pervasive extent of nicotine dependence among a population of young men. The pervasiveness of nicotine dependence across different psychiatric disorders suggests either a shared biological substrate or a common consequence of these disorders.

Tubal ectopic pregnancy following bilateral salphingectomies.

The reported incidence of ectopic pregnancy after bilateral salpingectomies is very low. We present a 31-year-old woman, who had an ectopic pregnancy after bilateral salpingectomies for previous ectopic pregnancies. A high index of suspicion for pregnancy is prudent to avoid missing an ectopic pregnancy despite a history of bilateral salpingectomies. Not all cases of ectopic pregnancies present with the classical triad of abdominal pain, vaginal bleeding and a period of amenorrhoea. A urine pregnancy test is a simple and inexpensive test, which should always be done to rule out pregnancy in a woman of reproductive age presenting with a period of amenorrhoea and abdominal symptoms.

Urological complications of laparoscopic hysterectomy: a four-year review at KK Women's and Children's Hospital, Singapore.

INTRODUCTION: This review assessed the incidence, predisposing conditions, and key surgical steps, where urological injuries occurred during laparoscopic hysterectomies at the Minimally Invasive Surgery Unit, KK Women's and Children's Hospital over a four-year period. METHODS: A retrospective review of 495 cases of laparoscopic assisted vaginal hysterectomies (LAVH) and total laparoscopic hysterectomy (TLH) from January 2001 to December 2004 was conducted. RESULTS: A total of eight urological injuries occurred, all within the initial two years of review. There were seven unintentional bladder injuries occurring at LAVH during dissection of the bladder off the uterovaginal attachment. The associated factors included previous caesarean section and fibroids. All bladder injuries were diagnosed and repaired intraoperatively with no long-term complications. A single case of ureteric injury occurred with TLH. The patient presented on the ninth postoperative day with fever and continuous vaginal discharge. The most likely aetiology was thermal damage from electrocautery used to secure haemostasis of the uterine artery pedicle. Ureteric re-implantation was eventually required in the patient. CONCLUSION: Urological injuries occurred in 1.6 percent of laparoscopic hysterectomies in our hospital. The predisposing factors include previous caesarean surgery, multiple fibroids and severe endometriosis. A definite learning curve exists with laparoscopic hysterectomy with a thorough knowledge of pelvic anatomy being an essential prerequisite for advanced pelvic surgery. Similarly, good exposure of the surgical field, vigilant dissection and judicious use of electro-surgery are important practices to adopt to prevent injuries.

Successful laparoscopic treatment of an abdominal pregnancy in the broad ligament.

Laparoscopic management of tubal ectopic pregnancy is the ideal form of treatment in most tertiary centres. Approximately 1% of ectopic pregnancies are abdominal pregnancies and these are usually managed by laparotomy. We present the first report of successful laparoscopic treatment of a 6.5 cm abdominal pregnancy located in the broad ligament of a 25-year-old woman.

Initial experience of laparoscopic management of apparent early endometrial cancer.

The traditional treatment for endometrial cancer is a staging laparotomy. In patients with apparent early stage disease, laparoscopic assisted vaginal hysterectomy has been employed as an alternative. We present a retrospective uncontrolled case series of 16 cases with apparent stage I endometrial cancer from November 1994 to April 2001 managed by laparoscopic assisted surgical staging (LASS) at the Gynaecological Oncology Department, KK Women's and Children's Hospital, Singapore. We have analysed outcome measures in terms of intra-operative complications, surgical morbidity and length of hospital stay, and have evaluated treatment success in terms of conversion to laparotomy, recurrent disease and mortality. Our findings indicate that LASS is a viable option in selected patients with apparent early endometrial cancer. Our initial experience with this modality of treatment thus proves that it has great potential in both treatment success and reduction of surgical morbidity. A larger case controlled trial would be ideal in order to substantiate these benefits.