Jeffrey Low | National University of Singapore (original) (raw)

Papers by Jeffrey Low

Singapore medical journal, 1995

This paper reviews the cases of eclampsia managed at the Kandang Kerbau Hospital with respect to ... more This paper reviews the cases of eclampsia managed at the Kandang Kerbau Hospital with respect to incidence, management, maternal and perinatal outcome. A retrospective analysis of eclampsia occurring over a 4-year period from January 1990 to December 1993. There were 27 cases of eclampsia among 59,599 deliveries during the study period, giving an overall incidence of 45.3 per 100,000 deliveries. Sixteen patients were nulliparous and the mean age was 29 years. Two-thirds of the cohort were booked patients and more than half of the cohort (55.6%) had their first seizure despite being in hospital. The majority (86.2%) of all seizures recorded occurred in the antepartum and intrapartum period. Eleven of the patients (40.7%) were asymptomatic prior to the first fit while headache was the commonest symptom of impending eclampsia in the remainder. Fifteen patients (55.6%) had significant proteinuria and this was associated with significant neonatal morbidity. The mean gestational age was 3...

Mitochondrion, 2011

Impaired respiration was proposed by Warburg to be responsible for aerobic glycolysis in cancer c... more Impaired respiration was proposed by Warburg to be responsible for aerobic glycolysis in cancer cells. However, intact mitochondria isolated from human ovarian and peritoneal cancer tissues exhibit substantive oxidative phosphorylating activities in terms of membrane potential, ATP biosynthesis and oxygen consumption. The specific activities of succinate, malate and glutamate dehydrogenases are comparable to reported values for human skeletal muscle, heart and liver but the rate of ATP production is one order of magnitude lower compared to human skeletal muscle. It was concluded that the TCA cycle is functional in these ovarian cancer tissues which contain OXPHOS competent mitochondria.

American Journal of Clinical Oncology, 2013

Oncotarget, Jan 7, 2015

Databases pertaining to various diseases provide valuable resources on particular genes of intere... more Databases pertaining to various diseases provide valuable resources on particular genes of interest but lack the molecular subtype and epithelial-mesenchymal transition status. CSIOVDB is a transcriptomic microarray database of 3,431 human ovarian cancers, including carcinoma of the ovary, fallopian tube, and peritoneum, and metastasis to the ovary. The database also comprises stroma and ovarian surface epithelium from normal ovary tissue, as well as over 400 early-stage ovarian cancers. This unique database presents the molecular subtype and epithelial-mesenchymal transition status for each ovarian cancer sample, with major ovarian cancer histologies (clear cell, endometrioid, mucinous, low-grade serous, serous) represented. Clinico-pathological parameters available include tumor grade, surgical debulking status, clinical response and age. The database has 1,868 and 1,516 samples with information pertaining to overall and disease-free survival rates, respectively. The database also...

Optics in Health Care and Biomedical Optics III, 2007

Near-infrared (NIR) Raman spectroscopy has shown promise to detect cancer and precancer in human ... more Near-infrared (NIR) Raman spectroscopy has shown promise to detect cancer and precancer in human through measuring the biomolecular and biochemical changes of tissue associated with diseases transformation. Most of studies of NIR Raman spectroscopy on tissue diagnosis are concentrated on the so-called fingerprint region (800-1800 cm -1 ), there are only very limited work for tissue diagnosis using the high wavenumber (2800-3700 cm -1 ) spectral features. The purpose of this study is to explore the ability of NIR Raman spectroscopy in high wavenumber region for the in vivo detection of cervical precancer. A rapid NIR Raman spectroscopy system associated with a fiber-optic Raman probe was used for the in vivo spectroscopic measurements. Multivariate statistical techniques including principal components analysis (PCA) and linear discriminant analysis (LDA) were employed to develop the diagnostic algorithm based on the spectral data from 2800-3700 cm -1 . Classification result based on PCA-LDA showed that high wavenumber NIR Raman spectroscopy can achieve the diagnostic sensitivity of 93.5% and specificity of 95.7% for precancer classification.

International Journal of Hematology, 2009

Non-Hodgkin lymphoma of vulva is exceedingly rare and it often poses a diagnostic challenge if th... more Non-Hodgkin lymphoma of vulva is exceedingly rare and it often poses a diagnostic challenge if their existence is not suspected. We report a patient who has primary cutaneous anaplastic large cell (C-ALCL) with an unusual presentation as a vulvar ulcer. She received a brief course of chemotherapy followed by local irradiation and has remained disease-free more than a year from

Annals of the Academy of Medicine, Singapore

The clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remain... more The clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remains controversial because little is known about the natural history of these tumours and pathological classifications do not correlate well with clinical outcomes and therefore cannot direct management. The objective of this study was to review a single institution's experience with STUMP and recommend a rational clinical approach to the management of patients with this histological diagnosis. A systematic review of all diagnoses of STUMP and leiomyosarcoma from the gynaecologic oncology and pathology databases between January 1970 and February 2006. A total of 18 diagnoses of STUMP and 72 diagnoses of Ieiomyosarcoma were made during the study period. None of these 72 cases of leiomyosarcoma had a prior diagnosis of STUMP. There were no recurrences in the 18 cases of STUMP with all 18 cases being registered as disease-free after 5 years. We recommend that patients with a diagnosis of S...

Annals of the Academy of Medicine, Singapore

Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advan... more Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore. Materials and Methods: A review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used. Results: Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 min...

Singapore medical journal, 2013

The risk of malignancy index (RMI) is a scoring system used to triage benign from malignant ovari... more The risk of malignancy index (RMI) is a scoring system used to triage benign from malignant ovarian masses. We compared the specificity and sensitivity of the four indices (RMI 1, RMI 2, RMI 3 and RMI 4) to discriminate a benign ovarian mass from a malignant one in a Southeast Asian population. This was a five-year retrospective study of women who were admitted for surgery due to ovarian masses. RMI scores were calculated based on standardised preoperative cancer antigen (CA)-125 levels, ultrasonography findings, menopausal status and tumour size based on ultrasonography. Postoperative histopathologic diagnosis was regarded as the definite outcome. Data were analysed using the Statistical Package for the Social Sciences, and Mann-Whitney U test was used to compare the individual RMI scores between the benign and malignant cases. Out of the 480 patients reviewed, 228 women aged 10-65 years were included in the study. Of these, 17 (7.5%) had malignant disease and 211 (92.5%) had benig...

Annals of the Academy of Medicine, Singapore, 2011

Annals of the Academy of Medicine, Singapore, 2004

The traditional indications for adjuvant pelvic radiotherapy (RT) for International Federation of... more The traditional indications for adjuvant pelvic radiotherapy (RT) for International Federation of Obstetrics and Gynecology (FIGO) stage Ib1 lymph nodes-negative cervix carcinoma following radical surgery based on histopathological factors, such as deep stromal invasion and lymphovascular space invasion (LVSI), were often inconsistently applied. The perceived risk of relapse was subjectively determined. This pilot study attempts to determine if the treatment outcome will be affected when the indication for RT is based on the Gynecologic Oncology Group (GOG) Risk Score (RS) and the field of adjuvant RT is tailored to the RS. From 1997 to 1999, 55 patients with FIGO stage Ib1 lymph nodes-negative cervical carcinoma limited to the cervix were prescribed RT following radical surgery, based on their RS, as follows: RS <40, RT is omitted; RS >40 to <120, modified (smaller) field RT; and RS >120, standard field pelvic RT. Their incidence and site of recurrence were compared wit...

Annals of the Academy of Medicine, Singapore, 2003

In 1988, FIGO added lymph node surgery to the staging system for endometrial cancer. This change ... more In 1988, FIGO added lymph node surgery to the staging system for endometrial cancer. This change remains controversial to date. From our study we aim to determine the significance of surgico-pathological parameters of endometrioid carcinoma for pelvic nodal metastases and survival, as well as to study the role of pelvic lymphadenectomy in the surgical treatment of this disease. A retrospective study was conducted in 198 women with endometrioid carcinoma who underwent full surgical staging including pelvic lymphadenectomy. The multiple variant regression analysis and the multi-variant logistic regression analysis were applied in the analysis of relationship. A positive correlation between nodal metastases and grade, myometrial invasion, peritoneal cytology, adnexal involvement, lympho-vascular space involvement and tumour size was found. For survival, significant prognosticators were grade, myometrial invasion, peritoneal cytology, lympho-vascular space involvement, adnexal involveme...

European journal of gynaecological oncology, 2003

A rare case of metastatic ovarian carcinoma arising from intrahepatic cholangiocarcinoma is repor... more A rare case of metastatic ovarian carcinoma arising from intrahepatic cholangiocarcinoma is reported and the literature reviewed. A 49-year-old woman presented with ascites and a left pelvic mass. Optimal debulking surgery was carried out including a segmental resection of segment 5/6 of the liver. Histopathology confirmed an intrahepatic cholangiocarcinoma metastatic to the ovaries and omentum. Distinguishing a metastatic tumor from a primary ovarian tumoris critical for appropriate management. A high index of suspicion intraoperatively and subsequent expert pathological review are essential in making the correct diagnosis.

European journal of gynaecological oncology, 2002

Ovarian germ cell malignancies pose a therapeutic challenge especially amongst young patients. Th... more Ovarian germ cell malignancies pose a therapeutic challenge especially amongst young patients. This is a retrospective review of 49 patients treated for such malignancies at KK Women's and Children's Hospital over a 13-year period. The relative proportion of such tumors was 6.2%. Age at presentation ranged from 14 to 51 years (mean 25.4 years). Forty-nine percent of tumors were immature teratomas and 81.6% had stage I disease. All patients had surgery initially and 67.3% required postoperative adjuvant chemotherapy. The patients were followed-up for one to 145 months (mean 51.6 months). All the 87.8% of patients on follow-up are alive and disease-free. There was one recurrence. Five patients had eight successful pregnancies, with no congenital anomalies. Mean duration when menstruation was resumed and regular was 2.5 and 3.5 months, respectively. With combination chemotherapy and conservative surgery, the outlook for patients is excellent, with emphasis on preservation of ov...

Singapore medical journal, 1992

A total of 84 patients had urodynamic evaluations. Twenty-two patients complained of stress incon... more A total of 84 patients had urodynamic evaluations. Twenty-two patients complained of stress incontinence, 41 patients complained of stress incontinence with other urinary symptoms and 21 complained of other urinary symptoms but not stress incontinence. Of those complaining of stress incontinence alone, 4 (18.2%) had detrussor instability, 11 (50%) had genuine stress incontinence and 7 (31%) had neither condition. Of those complaining of stress incontinence with other symptoms, 16 (39%) had detrussor instability, 19 (46.3%) had stress incontinence and 6 (14.6%) had neither condition. Of those complaining of other urinary symptoms except stress incontinence, 5 (23.8%) had detrussor instability, 3 (14.3%) had stress incontinence and 13 (61.9%) had neither condition. Urinary symptoms were found to have little correlation with the final diagnosis except for enuresis which was associated with detrussor instability.

The miRNA expression profiles of skin biopsies from 14 primary cutaneous anaplastic large cell ly... more The miRNA expression profiles of skin biopsies from 14 primary cutaneous anaplastic large cell lymphoma (C-ALCL) patients were analysed with miRNA microarrays using the same control group of 12 benign inflammatory dermatoses (BID) as previously used to study the miRNA expression profile of tumorstage mycosis fungoides (MF). We identified 13 differentially expressed miRNAs between C-ALCL and BID. The up-regulation of miR-155, miR-27b, miR-30c and miR-29b in C-ALCL was validated by miRNA-Q-PCR on independent study groups. Additionally, the miRNA expression profiles of C-ALCL were compared with those of tumor-stage MF. Although miRNA microarray analysis did not identify statistically significant differentially expressed miRNAs, miRNA-Q-PCR demonstrated statistically significantly differential expression of miR-155, miR-27b, miR-93, miR-29b and miR-92a between tumor-stage MF and C-ALCL. This study, the first describing the miRNA expression profile of C-ALCL, reveals differences with tumor-stage MF, suggesting a different contribution to the pathogenesis of these lymphomas.

Asian Pacific journal of cancer prevention : APJCP, 2012

To assess the health and economic burden of human papillomavirus (HPV)-related diseases (cervical... more To assess the health and economic burden of human papillomavirus (HPV)-related diseases (cervical cancer, cervical intraepithelial neoplasia (CIN) 1/2/3, and genital warts) in Singapore over a period of 25 years beginning in 2008. Incidence-based modeling was used to estimate the incidence cases and associated economic burden, with the assumption that age-stratified incidence rates will remain the same throughout the period of 25 years. The incidence rates in 2008 were projected based on data obtained from the National Cancer Registry for cervical cancer, and from a combination of published data and hospital registry review for CIN1/2/3 and genital warts. The population growth rate was factored into the projection of incidence cases over time. Direct cost data per cervical cancer and per CIN1/2/3 case were obtained from the financial database of large local hospitals while cost data for genital warts were obtained from the National Skin Center; these costs were multiplied by the num...

Journal of gynecologic oncology, 2014

To evaluate uterine and ovarian cancer mortality trends in East Asian countries. For three Asian ... more To evaluate uterine and ovarian cancer mortality trends in East Asian countries. For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women ≥20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has ...

Advanced Biomedical and Clinical Diagnostic Systems XI, 2013

Raman spectroscopy is a vibrational spectroscopic technique capable of optically probing the comp... more Raman spectroscopy is a vibrational spectroscopic technique capable of optically probing the compositional, conformational, and structural changes in the tissue associated with disease progression. The main goal of this work is to develop an integrated fingerprint (FP) and high wavenumber (HW) in vivo confocal Raman spectroscopy for simultaneous FP/HW tissue Raman spectral measurements. This work further explores the potential of integrated FP/HW Raman spectroscopy developed as a diagnostic tool for in vivo detection of cervical precancer. A total of 473 in vivo integrated FP/HW Raman spectra (340 normal and 133 precancer) were acquired from 35 patients within 1 s during clinical colposcopy. The major tissue Raman peaks are noticed around 854, 937, 1001, 1095, 1253, 1313, 1445, 1654, 2946 and 3400 cm -1 , related to the molecular changes (e.g., proteins, lipids, glycogen, nucleic acids, water, etc.) that accompany the dysplastic transformation of tissue. The FP (800 -1800 cm -1 ), HW (2800 -3800 cm -1 ) and the integrated FP/HW Raman spectra were analyzed using partial least squares-discriminant analysis (PLS-DA) together with the leave-one patient-out, cross-validation. The developed PLS-DA classification models and receiver operating characteristics (ROC) curves for the FP, HW and integrated FP/HW spectroscopy further discloses that the performance of integrated FP/HW Raman spectroscopy is superior to that of all others in discriminating the dysplastic cervix. The results of this work indicate that the co-contributions of underlying rich biochemical information revealed by the complementary spectral modalities (FP and HW Raman) can improve the in vivo early diagnosis of cervical precancer at clinical colposcopy

Sexual Health, 2014

Background Genital warts (GW) are a common sexually transmissible infection (STI) among young adu... more Background Genital warts (GW) are a common sexually transmissible infection (STI) among young adults and are associated with poor quality of life (QoL). We investigated the functional and psychosocial effect of GW on Singaporean patients and evaluated for any variations in QoL between genders. Patients with GW completed a standard questionnaire containing the Short Form-36 (SF-36) health survey and the Cuestionario Específico para Condiloma Acuminado in a cross-sectional survey. QoL deficits were determined by comparing the SF-36 scores with local population norms. Variations in SF-36 (norm-based) scores among patients with different characteristics were examined using multiple linear regressions. All data analyses were performed for male and female patients separately. The mean age of male (n=100) and female patients (n=80) was 31 years. The typical patient profile was male, ethnic Chinese, single, tertiary education level and presenting with recurrent warts and a history of prior STIs. Compared with the general population, male patients had similar or better functioning and wellbeing, whereas female patients had lower levels of productivity, mental health and general health. Among male patients, individuals afflicted with their first episode of GW and currently with a partner had better QoL. In contrast, for females, tertiary education, older age and being a nonsmoker were positively associated with better QoL. Patients with GW have a significant psychosocial burden, with differences in certain aspects of QoL between genders. We hope that with active intervention, we will be able to mitigate the associated negative impact to QoL.

Singapore medical journal, 1995

This paper reviews the cases of eclampsia managed at the Kandang Kerbau Hospital with respect to ... more This paper reviews the cases of eclampsia managed at the Kandang Kerbau Hospital with respect to incidence, management, maternal and perinatal outcome. A retrospective analysis of eclampsia occurring over a 4-year period from January 1990 to December 1993. There were 27 cases of eclampsia among 59,599 deliveries during the study period, giving an overall incidence of 45.3 per 100,000 deliveries. Sixteen patients were nulliparous and the mean age was 29 years. Two-thirds of the cohort were booked patients and more than half of the cohort (55.6%) had their first seizure despite being in hospital. The majority (86.2%) of all seizures recorded occurred in the antepartum and intrapartum period. Eleven of the patients (40.7%) were asymptomatic prior to the first fit while headache was the commonest symptom of impending eclampsia in the remainder. Fifteen patients (55.6%) had significant proteinuria and this was associated with significant neonatal morbidity. The mean gestational age was 3...

Mitochondrion, 2011

Impaired respiration was proposed by Warburg to be responsible for aerobic glycolysis in cancer c... more Impaired respiration was proposed by Warburg to be responsible for aerobic glycolysis in cancer cells. However, intact mitochondria isolated from human ovarian and peritoneal cancer tissues exhibit substantive oxidative phosphorylating activities in terms of membrane potential, ATP biosynthesis and oxygen consumption. The specific activities of succinate, malate and glutamate dehydrogenases are comparable to reported values for human skeletal muscle, heart and liver but the rate of ATP production is one order of magnitude lower compared to human skeletal muscle. It was concluded that the TCA cycle is functional in these ovarian cancer tissues which contain OXPHOS competent mitochondria.

American Journal of Clinical Oncology, 2013

Oncotarget, Jan 7, 2015

Databases pertaining to various diseases provide valuable resources on particular genes of intere... more Databases pertaining to various diseases provide valuable resources on particular genes of interest but lack the molecular subtype and epithelial-mesenchymal transition status. CSIOVDB is a transcriptomic microarray database of 3,431 human ovarian cancers, including carcinoma of the ovary, fallopian tube, and peritoneum, and metastasis to the ovary. The database also comprises stroma and ovarian surface epithelium from normal ovary tissue, as well as over 400 early-stage ovarian cancers. This unique database presents the molecular subtype and epithelial-mesenchymal transition status for each ovarian cancer sample, with major ovarian cancer histologies (clear cell, endometrioid, mucinous, low-grade serous, serous) represented. Clinico-pathological parameters available include tumor grade, surgical debulking status, clinical response and age. The database has 1,868 and 1,516 samples with information pertaining to overall and disease-free survival rates, respectively. The database also...

Optics in Health Care and Biomedical Optics III, 2007

Near-infrared (NIR) Raman spectroscopy has shown promise to detect cancer and precancer in human ... more Near-infrared (NIR) Raman spectroscopy has shown promise to detect cancer and precancer in human through measuring the biomolecular and biochemical changes of tissue associated with diseases transformation. Most of studies of NIR Raman spectroscopy on tissue diagnosis are concentrated on the so-called fingerprint region (800-1800 cm -1 ), there are only very limited work for tissue diagnosis using the high wavenumber (2800-3700 cm -1 ) spectral features. The purpose of this study is to explore the ability of NIR Raman spectroscopy in high wavenumber region for the in vivo detection of cervical precancer. A rapid NIR Raman spectroscopy system associated with a fiber-optic Raman probe was used for the in vivo spectroscopic measurements. Multivariate statistical techniques including principal components analysis (PCA) and linear discriminant analysis (LDA) were employed to develop the diagnostic algorithm based on the spectral data from 2800-3700 cm -1 . Classification result based on PCA-LDA showed that high wavenumber NIR Raman spectroscopy can achieve the diagnostic sensitivity of 93.5% and specificity of 95.7% for precancer classification.

International Journal of Hematology, 2009

Non-Hodgkin lymphoma of vulva is exceedingly rare and it often poses a diagnostic challenge if th... more Non-Hodgkin lymphoma of vulva is exceedingly rare and it often poses a diagnostic challenge if their existence is not suspected. We report a patient who has primary cutaneous anaplastic large cell (C-ALCL) with an unusual presentation as a vulvar ulcer. She received a brief course of chemotherapy followed by local irradiation and has remained disease-free more than a year from

Annals of the Academy of Medicine, Singapore

The clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remain... more The clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remains controversial because little is known about the natural history of these tumours and pathological classifications do not correlate well with clinical outcomes and therefore cannot direct management. The objective of this study was to review a single institution's experience with STUMP and recommend a rational clinical approach to the management of patients with this histological diagnosis. A systematic review of all diagnoses of STUMP and leiomyosarcoma from the gynaecologic oncology and pathology databases between January 1970 and February 2006. A total of 18 diagnoses of STUMP and 72 diagnoses of Ieiomyosarcoma were made during the study period. None of these 72 cases of leiomyosarcoma had a prior diagnosis of STUMP. There were no recurrences in the 18 cases of STUMP with all 18 cases being registered as disease-free after 5 years. We recommend that patients with a diagnosis of S...

Annals of the Academy of Medicine, Singapore

Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advan... more Introduction: Robotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore. Materials and Methods: A review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used. Results: Seventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 min...

Singapore medical journal, 2013

The risk of malignancy index (RMI) is a scoring system used to triage benign from malignant ovari... more The risk of malignancy index (RMI) is a scoring system used to triage benign from malignant ovarian masses. We compared the specificity and sensitivity of the four indices (RMI 1, RMI 2, RMI 3 and RMI 4) to discriminate a benign ovarian mass from a malignant one in a Southeast Asian population. This was a five-year retrospective study of women who were admitted for surgery due to ovarian masses. RMI scores were calculated based on standardised preoperative cancer antigen (CA)-125 levels, ultrasonography findings, menopausal status and tumour size based on ultrasonography. Postoperative histopathologic diagnosis was regarded as the definite outcome. Data were analysed using the Statistical Package for the Social Sciences, and Mann-Whitney U test was used to compare the individual RMI scores between the benign and malignant cases. Out of the 480 patients reviewed, 228 women aged 10-65 years were included in the study. Of these, 17 (7.5%) had malignant disease and 211 (92.5%) had benig...

Annals of the Academy of Medicine, Singapore, 2011

Annals of the Academy of Medicine, Singapore, 2004

The traditional indications for adjuvant pelvic radiotherapy (RT) for International Federation of... more The traditional indications for adjuvant pelvic radiotherapy (RT) for International Federation of Obstetrics and Gynecology (FIGO) stage Ib1 lymph nodes-negative cervix carcinoma following radical surgery based on histopathological factors, such as deep stromal invasion and lymphovascular space invasion (LVSI), were often inconsistently applied. The perceived risk of relapse was subjectively determined. This pilot study attempts to determine if the treatment outcome will be affected when the indication for RT is based on the Gynecologic Oncology Group (GOG) Risk Score (RS) and the field of adjuvant RT is tailored to the RS. From 1997 to 1999, 55 patients with FIGO stage Ib1 lymph nodes-negative cervical carcinoma limited to the cervix were prescribed RT following radical surgery, based on their RS, as follows: RS <40, RT is omitted; RS >40 to <120, modified (smaller) field RT; and RS >120, standard field pelvic RT. Their incidence and site of recurrence were compared wit...

Annals of the Academy of Medicine, Singapore, 2003

In 1988, FIGO added lymph node surgery to the staging system for endometrial cancer. This change ... more In 1988, FIGO added lymph node surgery to the staging system for endometrial cancer. This change remains controversial to date. From our study we aim to determine the significance of surgico-pathological parameters of endometrioid carcinoma for pelvic nodal metastases and survival, as well as to study the role of pelvic lymphadenectomy in the surgical treatment of this disease. A retrospective study was conducted in 198 women with endometrioid carcinoma who underwent full surgical staging including pelvic lymphadenectomy. The multiple variant regression analysis and the multi-variant logistic regression analysis were applied in the analysis of relationship. A positive correlation between nodal metastases and grade, myometrial invasion, peritoneal cytology, adnexal involvement, lympho-vascular space involvement and tumour size was found. For survival, significant prognosticators were grade, myometrial invasion, peritoneal cytology, lympho-vascular space involvement, adnexal involveme...

European journal of gynaecological oncology, 2003

A rare case of metastatic ovarian carcinoma arising from intrahepatic cholangiocarcinoma is repor... more A rare case of metastatic ovarian carcinoma arising from intrahepatic cholangiocarcinoma is reported and the literature reviewed. A 49-year-old woman presented with ascites and a left pelvic mass. Optimal debulking surgery was carried out including a segmental resection of segment 5/6 of the liver. Histopathology confirmed an intrahepatic cholangiocarcinoma metastatic to the ovaries and omentum. Distinguishing a metastatic tumor from a primary ovarian tumoris critical for appropriate management. A high index of suspicion intraoperatively and subsequent expert pathological review are essential in making the correct diagnosis.

European journal of gynaecological oncology, 2002

Ovarian germ cell malignancies pose a therapeutic challenge especially amongst young patients. Th... more Ovarian germ cell malignancies pose a therapeutic challenge especially amongst young patients. This is a retrospective review of 49 patients treated for such malignancies at KK Women's and Children's Hospital over a 13-year period. The relative proportion of such tumors was 6.2%. Age at presentation ranged from 14 to 51 years (mean 25.4 years). Forty-nine percent of tumors were immature teratomas and 81.6% had stage I disease. All patients had surgery initially and 67.3% required postoperative adjuvant chemotherapy. The patients were followed-up for one to 145 months (mean 51.6 months). All the 87.8% of patients on follow-up are alive and disease-free. There was one recurrence. Five patients had eight successful pregnancies, with no congenital anomalies. Mean duration when menstruation was resumed and regular was 2.5 and 3.5 months, respectively. With combination chemotherapy and conservative surgery, the outlook for patients is excellent, with emphasis on preservation of ov...

Singapore medical journal, 1992

A total of 84 patients had urodynamic evaluations. Twenty-two patients complained of stress incon... more A total of 84 patients had urodynamic evaluations. Twenty-two patients complained of stress incontinence, 41 patients complained of stress incontinence with other urinary symptoms and 21 complained of other urinary symptoms but not stress incontinence. Of those complaining of stress incontinence alone, 4 (18.2%) had detrussor instability, 11 (50%) had genuine stress incontinence and 7 (31%) had neither condition. Of those complaining of stress incontinence with other symptoms, 16 (39%) had detrussor instability, 19 (46.3%) had stress incontinence and 6 (14.6%) had neither condition. Of those complaining of other urinary symptoms except stress incontinence, 5 (23.8%) had detrussor instability, 3 (14.3%) had stress incontinence and 13 (61.9%) had neither condition. Urinary symptoms were found to have little correlation with the final diagnosis except for enuresis which was associated with detrussor instability.

The miRNA expression profiles of skin biopsies from 14 primary cutaneous anaplastic large cell ly... more The miRNA expression profiles of skin biopsies from 14 primary cutaneous anaplastic large cell lymphoma (C-ALCL) patients were analysed with miRNA microarrays using the same control group of 12 benign inflammatory dermatoses (BID) as previously used to study the miRNA expression profile of tumorstage mycosis fungoides (MF). We identified 13 differentially expressed miRNAs between C-ALCL and BID. The up-regulation of miR-155, miR-27b, miR-30c and miR-29b in C-ALCL was validated by miRNA-Q-PCR on independent study groups. Additionally, the miRNA expression profiles of C-ALCL were compared with those of tumor-stage MF. Although miRNA microarray analysis did not identify statistically significant differentially expressed miRNAs, miRNA-Q-PCR demonstrated statistically significantly differential expression of miR-155, miR-27b, miR-93, miR-29b and miR-92a between tumor-stage MF and C-ALCL. This study, the first describing the miRNA expression profile of C-ALCL, reveals differences with tumor-stage MF, suggesting a different contribution to the pathogenesis of these lymphomas.

Asian Pacific journal of cancer prevention : APJCP, 2012

To assess the health and economic burden of human papillomavirus (HPV)-related diseases (cervical... more To assess the health and economic burden of human papillomavirus (HPV)-related diseases (cervical cancer, cervical intraepithelial neoplasia (CIN) 1/2/3, and genital warts) in Singapore over a period of 25 years beginning in 2008. Incidence-based modeling was used to estimate the incidence cases and associated economic burden, with the assumption that age-stratified incidence rates will remain the same throughout the period of 25 years. The incidence rates in 2008 were projected based on data obtained from the National Cancer Registry for cervical cancer, and from a combination of published data and hospital registry review for CIN1/2/3 and genital warts. The population growth rate was factored into the projection of incidence cases over time. Direct cost data per cervical cancer and per CIN1/2/3 case were obtained from the financial database of large local hospitals while cost data for genital warts were obtained from the National Skin Center; these costs were multiplied by the num...

Journal of gynecologic oncology, 2014

To evaluate uterine and ovarian cancer mortality trends in East Asian countries. For three Asian ... more To evaluate uterine and ovarian cancer mortality trends in East Asian countries. For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women ≥20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has ...

Advanced Biomedical and Clinical Diagnostic Systems XI, 2013

Raman spectroscopy is a vibrational spectroscopic technique capable of optically probing the comp... more Raman spectroscopy is a vibrational spectroscopic technique capable of optically probing the compositional, conformational, and structural changes in the tissue associated with disease progression. The main goal of this work is to develop an integrated fingerprint (FP) and high wavenumber (HW) in vivo confocal Raman spectroscopy for simultaneous FP/HW tissue Raman spectral measurements. This work further explores the potential of integrated FP/HW Raman spectroscopy developed as a diagnostic tool for in vivo detection of cervical precancer. A total of 473 in vivo integrated FP/HW Raman spectra (340 normal and 133 precancer) were acquired from 35 patients within 1 s during clinical colposcopy. The major tissue Raman peaks are noticed around 854, 937, 1001, 1095, 1253, 1313, 1445, 1654, 2946 and 3400 cm -1 , related to the molecular changes (e.g., proteins, lipids, glycogen, nucleic acids, water, etc.) that accompany the dysplastic transformation of tissue. The FP (800 -1800 cm -1 ), HW (2800 -3800 cm -1 ) and the integrated FP/HW Raman spectra were analyzed using partial least squares-discriminant analysis (PLS-DA) together with the leave-one patient-out, cross-validation. The developed PLS-DA classification models and receiver operating characteristics (ROC) curves for the FP, HW and integrated FP/HW spectroscopy further discloses that the performance of integrated FP/HW Raman spectroscopy is superior to that of all others in discriminating the dysplastic cervix. The results of this work indicate that the co-contributions of underlying rich biochemical information revealed by the complementary spectral modalities (FP and HW Raman) can improve the in vivo early diagnosis of cervical precancer at clinical colposcopy

Sexual Health, 2014

Background Genital warts (GW) are a common sexually transmissible infection (STI) among young adu... more Background Genital warts (GW) are a common sexually transmissible infection (STI) among young adults and are associated with poor quality of life (QoL). We investigated the functional and psychosocial effect of GW on Singaporean patients and evaluated for any variations in QoL between genders. Patients with GW completed a standard questionnaire containing the Short Form-36 (SF-36) health survey and the Cuestionario Específico para Condiloma Acuminado in a cross-sectional survey. QoL deficits were determined by comparing the SF-36 scores with local population norms. Variations in SF-36 (norm-based) scores among patients with different characteristics were examined using multiple linear regressions. All data analyses were performed for male and female patients separately. The mean age of male (n=100) and female patients (n=80) was 31 years. The typical patient profile was male, ethnic Chinese, single, tertiary education level and presenting with recurrent warts and a history of prior STIs. Compared with the general population, male patients had similar or better functioning and wellbeing, whereas female patients had lower levels of productivity, mental health and general health. Among male patients, individuals afflicted with their first episode of GW and currently with a partner had better QoL. In contrast, for females, tertiary education, older age and being a nonsmoker were positively associated with better QoL. Patients with GW have a significant psychosocial burden, with differences in certain aspects of QoL between genders. We hope that with active intervention, we will be able to mitigate the associated negative impact to QoL.