Associations of clinical and dosimetric parameters with late rectal toxicities after radical intensity-modulated radiation therapy for prostate cancer: a single-centre retrospective study.

INTRODUCTION: This study assessed the incidence of late rectal toxicities and evaluated potential predictive factors for late proctitis in patients treated with prostate-specific intensity-modulated radiotherapy in Hong Kong. METHODS: This retrospective longitudinal observational study included patients with localised prostate cancer who were treated with intensity-modulated radiation therapy in an oncology unit in Hong Kong between January 2007 and December 2011, and who had >1 year of follow-up. Clinical, pharmacological, and radiation parameters were recorded. Toxicities were measured by Common Terminology Criteria for Adverse Events version 4. RESULTS: In total, 232 patients were included in this analysis. The mean follow-up time was 7.3 ± 2.1 years and 46.5% of the patients had late rectal toxicities. Late proctitis occurred in 30.5% of patients; 25% of the patients with late proctitis exhibited grade ≥2 toxicity. Median onset times for late proctitis and rectal bleeding were 15 and 18.4 months, respectively. Multivariable regression showed increased odds for the occurrence of late proctitis in patients with older age (odds ratio [OR]=1.11, 95% confidence interval [CI]=1.04-1.19, P=0.003), higher V70 (OR=1.08, 95% CI=1.01-1.15, P=0.027), and presence of acute rectal toxicities (OR=4.47, 95% CI=2.37-8.43, P<0.001). Antiplatelet use was not significantly associated with the occurrence of late proctitis (OR=1.98, 95% CI=0.95-4.14, P=0.07). CONCLUSIONS: The incidence of late rectal toxicities was considerable among patients in this study. Clinicians should consider the possibility of late proctitis for patients with older age, acute rectal toxicities, and higher V70. High doses to rectal volumes should be limited because of the significant association with V70.

A brief history of psychiatry in Singapore.

The development of psychiatric services in Singapore during the last 150 years can be divided into four distinct, albeit overlapping, phases: (1) the origins of the Lunatic Asylum; (2) the interruption caused by the Japanese Occupation, and the post-war years; (3) the training of local psychiatrists and mental health professionals; and (4) the development of general hospital psychiatry and community mental health services. Early psychiatry in Singapore was essentially British psychiatry as an outpost but modified by local conditions. Modern psychiatry in Singapore has its roots in Singapore's colonial past and is strongly influenced by Western psychiatry. It has come a long way since its humble beginnings when the first mental hospital was established in 1841.

Grief revisited.

The article serves to examine the cultural influences on attitudes towards the deceased and bereaved, as well as on the practice of mourning, and to revisit normal and pathological variants of grief. Grief is a subjective state of psychological and physiological reaction to the loss of a loved one. Reaction to the loss is experienced internally in a uniform manner across cultures. However, mourning, the voluntary social expression of the loss, varies from culture to culture. Rituals provide a standardised mode of behaviour, which helps to relieve the sense of uncertainty or loss. There were reports of ghost sightings involving foreign tourists in the 6 worst-hit southern provinces in Thailand following the tsunami tragedy. This phenomenon of "mass hallucinations" is understandable from the cultural perspective. New models of grief have been developed to account for the individuality and diversity of grief and to encompass the social, behavioural and spiritual dimensions of loss as well as those of the psychological and physical. Clinically, the duration of grief reactions varies widely, depending on the nature of the loss and the connection to the deceased. In the case of the tsunami tragedy, with relatives missing, homes swept away and familiar neighbourhoods turned into wastelands, many victims are likely to have complicated grief. Traumatic grief, which includes a prominent component of separation distress characterised by yearning and searching and frequent "bittersweet" recollections of the deceased, has been associated with long-term dysfunction. Grief work utilising the traumatic grief treatment protocol appears to be a promising intervention.

Milestones of the medical school and medical progress of Singapore over the past 100 years.

The Medical School started off in an old female lunatic asylum on the site of the general hospital at Sepoy Lines. It was founded on 3 July 1905 and was called the Straits and Federated Malay States Government Medical School. In 1916, the Licentiate in Medicine and Surgery (LMS) was recognised fully by the General Medical Council of Britain as a registrable qualification. In 1921, the medical school was renamed King Edward VII College of Medicine to reflect its academic status. In 1926, the College and its hospitals were inspected by Sir Richard Needham, who had been sent by the General Medical Council of Great Britain. In his report, he told the Council that in his opinion, the graduates should be given the MBBS degree because of the high standard of the Medical School. The medical school was closed by the Japanese on 16 February 1942. After the end of World War II, the College of Medicine resumed classes in June 1946. In 1962, the medical faculty became the Faculty of Medicine of the University of Singapore. From 1984 to 1986, following the university's move to Kent Ridge, the Faculty's clinical school also moved to the National University Hospital. In 2004, plans were well underway for the opening of the country's second medical school on the grounds of the Singapore General Hospital.

The first graduates in 1910.

The Medical School in Singapore was founded on 3 July 1905 and named the Straits and Federated Malay States Government Medical School. There were 23 students in the first enrollment; 16 students attended the full course, while 7 attended a 2-year course for hospital assistants. The pioneer group of 7 that graduated in May 1910 (the Magnificent Seven) consisted of Drs Chen Su Lan, Edwin Williborod deCruz, and John Gnanapragasam from Singapore; Drs Willie Carnegie and Mark W Chill from Penang; Dr SR Krishnan from Seramban and Dr John Scott Lee from Ipoh. In December 1910, a further 6 students graduated. Of this first batch of 13 graduates in 1910, we describe the careers of 6; no records exist of the remaining 7.

Subungual exostosis following toe nail removal--case report.

Removal of toe nail is a minor procedure that can be under ring block with no significant complications. We report the case of a young lady who developed a rapidly growing subungual exostosis on her right great toe following nail removal. Inadvertent iatrogenic injury to the nail bed and underlying phalangeal periosteum during nail removal might have triggered off rapid bone growth resulting in the large exostosis. To our knowledge, this aetiology for subungual exostosis formation has not been reported before.

Charles Bonnet syndrome in Asian patients in a tertiary ophthalmic centre.

AIMS: To describe the epidemiology of Charles Bonnet syndrome (CBS) among patients in an Asian tertiary ophthalmic centre and to describe the characteristics of the hallucinations experienced. METHODS: 1077 consecutive patients aged 50 years and above were asked a standardised question to determine if they had ever experienced formed visual hallucinations. All patients who experienced these symptoms were further interviewed using a detailed, standardised questionnaire to ascertain if they met the diagnostic criteria established for CBS. RESULTS: There were 491 men (45.6%) and 586 women (54.4%). The best corrected visual acuity ranged from 20/20 to light perception in the better seeing eye and from 20/20 to no light perception in the worse seeing eye. Four patients (0.4%) were diagnosed with CBS; two men and two women. There were two Chinese and two Indians. The average age of the CBS patients was 76.3 years (range 65-90 years). Two patients had cataracts, one had glaucoma, and one had both cataracts and glaucoma. A wide variety of visual hallucinations were reported. Three out of four patients experienced a negative reaction to their hallucinations. Only one patient had discussed his symptoms with a doctor. CONCLUSIONS: This is the first report on the epidemiology of CBS in Asian patients. The prevalence rate of CBS (0.4%) is slightly lower than in comparable studies in non-Asian populations. The nature of the hallucinations experienced were similar to those previously reported.

How the Mental Hospital was renamed Woodbridge Hospital in 1951.

This essay consists of three parts. The first, based on Woodbridge Hospital records, explains how the Mental Hospital was renamed Woodbridge Hospital in 1951, an issue which had received intermittent press publicity, though its full details have not been published before. The second part of the essay traces the exact location of the wooden bridge after which the hospital is named. The last part concerns a missing photograph of a Woodbridge Hospital outside Singapore.

Qigong-induced mental disorders: a review.

OBJECTIVE: This review article aims to explore current opinions on Qigong-induced mental disorders, an entity which is unfamiliar to Western psychiatrists. METHOD: Relevant literature published in Chinese and English is reviewed. RESULTS: The review is divided into three sections: first, there is brief consideration of the historical development of Qigong in traditional Chinese medicine and its role in psychiatry; second, there is a review of the literature published on Qigong deviations and Qigong-induced mental disorders; and third, there is a discussion on the aetiological role of Qigong in these conditions. CONCLUSIONS: Qigong remained veiled in secrecy and available only to the elite until the early 1980s. Despite the widespread use of Qigong, there is a conspicuous lack of controlled data regarding its effects on mental health. Qigong, when practised inappropriately, may induce abnormal psychosomatic responses and even mental disorders. However, the ties between Qigong and mental disorders are manifold, and a causal relationship is difficult to establish. Many so-called 'Qigong-induced psychoses' may be more appropriately labelled 'Qigong-precipitated psychoses', where the practice of Qigong acts as a stressor in vulnerable individuals.

Wei han zheng (frigophobia): a culture-related psychiatric syndrome.

OBJECTIVE: The aim of this paper is to describe a clinical case of wei han zheng (frigophobia) in Singapore. CLINICAL PICTURE: A 45-year-old Chinese housewife had morbid fears of cold, in terms of temperature, and food of a cold (yin) nature, and a variety of somatic symptoms. She stopped working, adopted various measures to avoid exposure to cold air and wind, and took dietary precautions. TREATMENT AND OUTCOME: She received intermittent follow-ups over the following 8 years. An episodic, albeit recurrent, course was documented. Treatment consisted of symptomatic relief using low dose anxiolytics and antidepressants, and psychological interventions. CONCLUSION: Frigophobia is closely related to, and strongly influenced by, cultural beliefs. In therapy, it would be pertinent to consider the patient's own cultural beliefs about the illness as compared to the therapist's model of illness, and how matching of these could be negotiated.