Uterine artery embolisation for symptomatic fibroids in a tertiary hospital in Singapore.

INTRODUCTION: Transcatheter uterine artery embolisation (UAE) for the treatment of symptomatic uterine enlargement due to fibroids has been performed in several overseas centres with promising results. We report our experience with UAE in Singapore General Hospital. MATERIALS AND METHODS: Twenty women with symptomatic uterine fibroids who declined surgery were treated by transcatheter UAE. The uterine arteries were selectively catheterised and embolised with polyvinyl alcohol particles. Post-procedure analgesia was administered via a patient-controlled analgesia pump. The patients were followed up at regular intervals clinically and with transabdominal ultrasonography. RESULTS: Transcatheter UAE was performed on all patients with no major complications. Nineteen patients had both uterine arteries embolised while 1 patient had only the right uterine artery embolised on account of hypoplasia of the left uterine artery. The mean hospital stay was 3.5 days (range, 2 to 9). At a mean follow-up of 56 weeks (range, 6 to 168), all patients reported improvements in their presenting symptoms. Objective improvement in terms of reduction of uterine and fibroid sizes was determined on ultrasonography. The median size of the uterine volume decreased from 308 to 187 mL while the median diameter of the largest fibroid reduced from 6.2 to 4.6 cm. The median haemoglobin level increased to 12.7 g/dL from the pre-procedural median of 9.9 g/dL. One patient, who initially responded with a decrease in uterine and dominant fibroid size, became symptomatic (menorrhagia) at 6 months post-embolisation. She underwent a repeat procedure with complete resolution of symptoms. A second patient had recurrence of symptoms at 12 months, but was subsequently lost to follow-up. CONCLUSION: Mid-term results of UAE for the treatment of symptomatic fibroids in our hospital indicate this to be a safe and effective therapeutic option.

Non-consensual double reading in the Singapore Breast Screening Project: benefits and limitations.

INTRODUCTION: The aims of this study were to assess the efficacy of non-consensual double reading (against single reading) in the Singapore Breast Screening Project (SBSP) and to compare the benefits (increase in cancer detection) and limitations (increase in recall and biopsy) with published data. MATERIALS AND METHODS: The data from the SBSP was retrospectively analysed and the recommendations of the first and second readers were evaluated separately with regards to rate of recall, biopsy and cancer detection. The mean second screener contribution (MSSC) was also calculated for double reading. RESULTS: In the SBSP, double reading detected 7 additional cancers (5.2% of cancers detected) compared with single reading and the MSCC was 5.5%. Double reading also resulted in 632 additional recalls, with a decrease in the positive predictive value (PPV) of cancer in the recalled women from 8.2% for single reading to 6.1% for double reading. An additional 30 biopsies were performed with double reading which represented a small decrease in PPV (41% compared to 42.9% for single reading). CONCLUSION: In the SBSP, non-consensual double reading (compared to single reading) resulted in a modest increase in cancer detection (MSSC, 5.5%) with a modest decrease in PPV of recall (2.1%) and biopsy (1.9%). These findings were consistent with that of published data and non-consensual double reading is thus recommended.

Clinics in diagnostic imaging (64). Invasive pulmonary aspergillosis.

A 30-year-old woman undergoing chemotherapy for acute myeloid leukemia developed fever. Chest radiograph showed ill-defined nodules in the mid and lower zones. CT showed multiple nodules that cavitated with commencement of anti-fungal therapy. Follow-up CT showed complete resolution of the pulmonary nodules, confirming the diagnosis of invasive pulmonary aspergillosis. Aspergillus fumigatus presents clinically as aspergilloma, invasive pulmonary aspergillosis or allergic bronchopulmonary aspergillosis depending on the immune status of the host. The different manifestations are discussed and imaging features of representative clinical case studies are illustrated.

Glenohumeral abduction and the long head of the biceps.

The role of the long head of the biceps in glenohumeral abduction and the accompanying external rotation is an unsettled issue. Automatic external rotation however has been previously demonstrated during passive abduction, with intact long head and the absence of factors traditionally considered to influence the rotation such as the coracoacromial arch and muscles surrounding the joint. The present study on the anatomy of the tendon of the long head in relation to passive abduction shows that not only is the tendon likely to be harmed by forced abduction without external rotation but the course of the tendon itself is such that activity in the long head during abduction is likely to influence external rotation that in turn prevents tendon impingement between greater tuberosity and glenoid labrum and allows glenohumeral abduction to be carried further towards completion.