1.Observation of Ureteric Diameter in Negative Intravenous Urogram in Hospital Universiti Kebangsaan Malaysia
Siong Lung Wong ; Hamzaini Abdul Hamid
Malaysian Journal of Medical Sciences 2010;17(2):4-9
Background: This study observed the widest ureteric diameter in negative intravenous
urogram (IVU) examinations using low osmolar contrast media.
Methods: We reviewed a total of one hundred and eighty four ureters from 92 negative
IVUs.
Results: The results show a mean diameter for the abdominal ureter of 4.19 mm with an SD
of 1.27 mm and a mean pelvic ureteric diameter of 4.45 mm with an SD of 1.37 mm. The upper limits
for abdominal ureter and pelvic ureter based on a confidence interval of 95% were 4.37 mm and 4.64
mm, respectively.
Conclusions: There was no significant difference between the right and left ureteric diameter
in both female and male subjects. There was no significant correlation between ureteric diameters
and the age of subjects, from the second to the eighth decades.
2.Radiation Dose Management in Fluoroscopy Procedures: Less is More?
Siti Farizwana Mohd Ridzwan ; S. Elavarasi Selvarajah ; Hamzaini Abdul Hamid
Malaysian Journal of Health Sciences 2016;14(2):103-109
The aims of this study are (1) to determine the scattered radiation dose levels in routine fluoroscopy procedures and (2) to compare them with the equivalent chest x-rays and also (3) to monitor common techniques and radiation safety measures taken by the medical officers. The study covered a sample of 105 fluoroscopic procedures performed by 18 medical officers. Each officer wore a personal pocket dosimeter inside the lead gown during each procedure. A digital dosimeter was placed near the detector of the fluoroscopy unit while a survey meter was positioned at the control panel area to record the dose levels. There were 14 types of examination included in this study. The total number of images captured was found to be the highest in barium swallow examination with 115 images, almost five times higher compared to the common practices. The longest screening time was observed in barium enema examination which is 9.15 seconds. The median of the scattered dose level was the highest in barium meal examination (165.50 μSv) which is equivalent to 8.28 times of average dose impart by chest x-ray examinations. The number of images and the length of screening time depend on the competency levels of the medical officers. They capture as many images as possible to avoid missing any abnormalities, therefore it will always be better if the fluoroscopist is consulted during each case. They should also consistently practice essential protection by minimizing exposure time, maximizing distance from the source tube and utilizing the radiation shielding.
Fluoroscopy
;
Radiation Dosage
3.Radiation Dose Comparison between Intravenous Urography (IVU) and Unenhanced Helical Computed Tomography (UHCT) Urography
Akmal Sabarudin ; Kanaga Kumari Chelliah ; Hamzaini Abdul Hamid
Malaysian Journal of Health Sciences 2014;12(2):9-16
Intravenous urography (IVU) and unenhanced helical computed tomography (UHCT) urography are the two main procedures
performed in the radiological investigation for urolithiasis (urinary stone). However, exposure to ionizing radiation is the
main concern in both procedures. Therefore, a dose comparison study was conducted between IVU and UHCT urography
procedures to determine the optimum exposure parameters in this study. An anthropomorphic whole body phantom was
used following the exact procedure of UHCT urography and series of imaging for IVU with an administration of contrast
media. Three different exposure parameters were used for IVU with 75 kVp, 80 kVp and 85 kVp while 100 kVp, 120 kVp
and 140 kVp for UHCT urography respectively. As a result, the radiation doses for IVU were 1.40 mSv, 2.10 mSv and
2.79 mSv corresponding to 75 kVp, 80 kVp and 85 kVp. On the other hand, the radiation doses for UHCT urography were
0.76 mSv, 1.32 mSv and 1.82 mSv for 100 kVp, 120 kVp and 140 kVp, respectively. However the optimum image was
obtained at 85 kVp for IVU and 120 kVp for UHCT urography. In conclusion, the doses obtained from IVU were consistently
higher than UHCT urography but not signifi cantly different
4.Predicting Outcome of Trial of Voiding Without Catheter in Acute Urinary Retention with Intravesical Prostatic Protrusion
Osman Syazarina Sharis ; Md Zainuddin Zulkifli ; Abdul Hamid Hamzaini
Malaysian Journal of Medical Sciences 2013;20(1):56-59
Background: Acute urinary retention (AUR) is one of the most serious complications of benign prostatic hypertrophy. This study was done to predict the outcome of trial of voiding without catheter (TWOC) in patients with AUR with intravesical prostatic protrusion (IPP) detected on transabdominal ultrasound. Other factors such as prostatic volume and patient’s age were also assessed.
Method: Patients with a first episode of AUR secondary to benign prostatic hypertrophy were assessed with ultrasound following bladder catheterization. The IPP was measured and graded (grade 1 is 5 mm or less, grade 2 is 5–10 mm and grade 3 is more than 10 mm). Success of TWOC was then correlated with the degree of IPP.
Results: A total of 32 patients with AUR were included in the study. Patients with grade 3 IPP were found to have a significant failure rate compared to grade 1 (P = 0.022) and grade 2 (P = 0.041).
Conclusion: Intravesical prostatic protrusion is a useful predictor of success of TWOC in patients with AUR. Patients with grade 3 IPP on ultrasound would benefit from TWOC and warrant earlier definitive surgical treatment.
5.Necrotizing Fasciitis on the Right Side of the Neck with Internal Jugular Vein Thrombophlebitis and Septic Emboli: A Case of Lemierre’s-Like Syndrome
Dang Nguyen ; Yazmin Yaacob ; Hamzaini Hamid ; Sobri Muda
Malaysian Journal of Medical Sciences 2013;20(5):70-78
Lemierre’s syndrome (LS) is a rare life-threatening infective condition typically starting with an oropharyngeal infection causing thrombophlebitis and metastatic abscesses. The most common aetiology of LS is Fusobacterium necrophorum; however, it can also occur after infection with other organisms. LS mainly affects young healthy adults. The initial infection site can be in the head and neck or in the abdomen. The morbidity rate of this disease is high despite aggressive treatments. In this article, we report a 63-year-old male patient with uncontrolled diabetes mellitus, presenting with Klebsiella pneumoniae infection-induced necrotizing fasciitis on the right side of the neck, leading to LS.
Fasciitis, Necrotizing
;
Lemierre Syndrome
;
Fusobacterium necrophorum
;
Klebsiella pneumoniae
6.Contrast enhanced Voiding Urosonography (ce-VUS) as a radiation-free technique in the diagnosis of vesicoureteric reflux: Our early experience
Faizah Mohd Zaki ; Hamzaini Abdul Hamid ; Kanaheswari Yoganathan ; Dayang Anita Abdul Aziz ; Zulfiqar Muhamed Annuar
The Medical Journal of Malaysia 2015;70(5):269-272
Objective: Contrast-enhanced ultrasound has become
increasingly utilised as an alternative imaging modality for
the diagnosis of vesicoureteric reflux (VUR) in paediatric
patients. The study objective is to evaluate the efficacy of
contrast enhanced Voiding Urosonography (ce-VUS)
compared with fluoroscopic micturating
cystourethrography (MCU) in the detection of VUR.
Methods: This prospective study was carried out between
July 2011 and January 2013 on paediatric patients who
underwent MCU. All consented patients would undergo ceVUS
prior to MCU. We documented the epidemiology details,
the number of Kidney-Ureter (K-U) unit studied, baseline
renal and bladder sonogram, as well as presence of VUR on
ce-VUR. The technique for ce-VUS was standardized using
normal saline to fill the bladder prior to administration of
SonoVue® (2.5 ml) to assess the kidney-ureter (K-U) unit.
Dedicated contrast detection software was used to discern
the presence of microbubbles in the pelvicaliceal system
(PCS). The findings were then compared with MCU.
Results: 27 paediatric patients were involved in the study [17
males (63%) and 10 females (37%)] involving 55 K-U units
(one patient had a complete duplex system). MCU detected
VUR in 10 K-U units while ce-VUS detected VUR in 8 out of
the 10 K-U units. There were 2 false negative cases (both
Grade 1) with ce-VUS. The sensitivity, specificity, accuracy,
positive predictive value, and negative predictive value of
ce-VUS were 80%, 98%, 95%, 89% and 96%, respectively.
Conclusion: ce-VUS is a sensitive and specific radiation-free
alternative for the detection of VUR in the paediatric
population.
Urinary Tract Infections
7.Polyps! Polyps! And More Polyps! - The First Case of Cronkhite-Canada Syndrome in Malaysia
Rafiz Abdul Rani ; Fara Rahidah Hussin ; Hamzaini Abdul Hamid ; Isa Mohd Rose ; Raja Affendi Raja Ali
The Medical Journal of Malaysia 2016;71(1):37-38
Cronkhite-Canada Syndrome (CCS) is a syndrome
characterised by a constellation of signs including but not
limited to onychodystrophy of the finger and toe nails, skin
hyperpigmentation and alopecia. Endoscopic features
showed hamartomatous polyps involving all segments of
the gastrointestinal tract with the characteristic exception of
being oesophageal sparring. These polyps show
confirmation by the presence of eosinophils and mast cells
at the lamina propria upon histological studies.
Intestinal Polyposis
8.Renal doppler assessment in differentiating obstructive from non-obstructive hydronephrosis in children
Nadzri Misni ; Erica Yee Hing ; Hamzaini Abdul Hamid ; Faizah Mohd Zaki ; Aini AbAziz ; Kanaheswari Yoganathan ; Zulfiqar Mohd Annuar
The Medical Journal of Malaysia 2015;70(6):346-350
background: to determine the usefulness of Doppler
ultrasound measurement of resistive index (RI) in
differentiating obstructive from non-obstructive
hydronephrosis in children.
Methods: From August 2011 to November 2012, renal
Doppler assessments of the intra-renal renal arteries were
performed on 16 children (19 kidneys) with congenital
hydronephrosis. the independent t-test was used to
assess for significant difference in RI values between those
with obstructive hydronephrosis (6 kidneys) and those with
non-obstructive hydronephrosis (13 kidneys) as determined
by dynamic renal scintigraphy. the assessor was blinded to
the clinical findings and scintigraphy results.
Results: RI was significantly different between obstructive
and non-obstructive hydronephrosis. Obstructive
hydronephrosis returned higher RI values, with mean RI of
0.78. Mean RI in non-obstructive hydronephrosis was 0.70,
and the difference was significant (p <0.05). the sensitivity
and specificity of Doppler ultrasound were 100% and 53%
respectively.
conclusion: Doppler ultrasound measurement of resistive
index is useful in differentiating obstructive from nonobstructive
hydronephrosis and provides an alternative
non-ionizing investigation other than dynamic renal
scintigraphy.
9.Association of Cobb angle progression and neuraxial abnormality on MRI in asymptomatic Adolescent Idiopathic Scoliosis
Faizah Mohd Zaki ; Ng Kai Ling ; Te Boon Chin ; Mohd Hafizuddin Azman ; Nur Aifaa Liah ; Nurhanisah Mohd Razali ; Azmi Baharudin ; Hamzaini Abdul Hamid
The Medical Journal of Malaysia 2016;71(3):122-125
Background: Detection of neuraxial abnormality in
neurologically asymptomatic adolescent idiopathic
scoliosis (AIS) is crucial prior to surgery. It can only be
detected on magnetic resonance imaging (MRI), which was
not routinely done in this group of patient. On the other
hand, whole spine radiographs for measurement of Cobb
angle have been routinely included during clinic follow-up.
This study aimed to determine the correlation between Cobb
angle progression and neuraxial abnormality finding on MRI
in asymptomatic AIS.
Methods: A retrospective study was conducted in the
Orthopaedic department of a tertiary hospital. Patients with
asymptomatic AIS aged 10-20 years who attended scoliosis
clinic from year 2007 to 2010 was reviewed. Patients who
had whole spine MRI and two vertebral radiographs at least
one year apart were further selected. Statistical analysis was
done to see the association between Cobb angle
progression and neuraxial abnormality on MRI.
Results: The mean age at first presentation was 14.4 years
old. Female (n=249) to male (n=50) ratio was 5:1. Only 19
patients fulfilled the selection criteria. There were 5 patients
(26.3%) who had neuraxial abnormalities. The mean curve
progression was 7.05° (range from -5° to 28°). Patients with
and without neuroaxial abnormality showed mean curve
progression of 0.6º and 9.36° respectively. There was no
significant association between Cobb angle progression
and neuroaxial abnormality (p=1.000).
Conclusion: Cobb angle progression is not a reliable
indicator for predicting neuroaxial abnormality in patients
with asymptomatic AIS. However, this study stressed the
need to perform MRI prior to operation to document any
associated neuraxial abnormality in clinically asymptomatic
AIS patients.
10.Radiation Dose Comparison in CT Thorax, CT Abdomen and CT Thorax-Abdomen-Pelvis (TAP) Using 640-and 160-Slice Computed Tomography (CT) Scanners (Perbandingan Dos Sinaran dalam Pemeriksaan Tomografi Berkomputer (CT) Toraksik, Abdomen dan Toraksik-Abdomen-Pelvis (TAP) antara 640 dan 160 Hirisan)
Gan Ying Shen ; Akmal Sabarudin ; Hamzaini Abdul Hamid ; Mazli Mohd Zain ; Muhammad Khalis Abdul Karim ; KHADIJAH MOHAMAD NASSIR
Malaysian Journal of Health Sciences 2020;18(No.1):29-36
This study was carried out to compare the effective dose, size specific dose estimation (SSDE) and scan length between genders and between CT scanner with different slice number. A total of 245 set data of radiation dose and scan length for CT scanning procedure involving thorax, abdomen and pelvis regions were obtained retrospectively for comparisons. 111 patients (60 males and 51 females) were scanned using 160-slices CT scanner while 134 patients (71 males and 63 females) were scanned using 640-slices CT scanner. Generally, there were no significant differences in the radiation dose and scan length among genders. However, differences for SSDE in CT thorax and CT thorax-abdomen-pelvis (TAP) protocols exist whereby in CT thorax protocol, 640-slices CT scanner had a significantly higher value of SSDE (9.06±2.67 mGy) than that in 160-slices CT scanner (7.82±1.33 mGy). Similarly to the CT TAP protocol, whereby 640-slices CT scanner had a significantly lower value in SSDE (9.17±1.59 mGy) than that in 160-slices CT scanner (10.76±3.72 mGy). In conclusion, there was no significant difference in the radiation dose and scan length between genders but significant difference was only observed in SSDE due to the presence of body size variation among the study population especially in different CT scanners.