A 57-year-old woman with diabetes and hypertension presented with acute calculous cholecystitis and cholangitis. Incidentally, two splenic lesions were identified on formal abdominal ultrasound, one demonstrating the sonographic bright band sign. Computed tomography confirmed splenic infarctions and also revealed portosplenic vein thrombosis. Haematological workup, including JAK2 V617F mutation analysis, led to a diagnosis of polycythaemia vera, contributing to cholelithiasis via increased cell turnover and thrombosis due to hyperviscosity. She was started on venesection and hydroxycarbamide and discharged well. However, she defaulted follow -up and re -presented two years later with disseminated intravascular coagulation, eventually succumbing to the illness. This case highlights the utility of the sonographic bright band sign in identifying splenic infarction and distinguishing it from other hypoechoic splenic lesions

A 57-year-old woman with diabetes and hypertension presented with acute calculous cholecystitis and cholangitis. Incidentally, two splenic lesions were identified on formal abdominal ultrasound, one demonstrating the sonographic bright band sign. Computed tomography confirmed splenic infarctions and also revealed portosplenic vein thrombosis. Haematological workup, including JAK2 V617F mutation analysis, led to a diagnosis of polycythaemia vera, contributing to cholelithiasis via increased cell turnover and thrombosis due to hyperviscosity. She was started on venesection and hydroxycarbamide and discharged well. However, she defaulted follow -up and re -presented two years later with disseminated intravascular coagulation, eventually succumbing to the illness. This case highlights the utility of the sonographic bright band sign in identifying splenic infarction and distinguishing it from other hypoechoic splenic lesions

Spontaneous Large Renal Pelvis Haematoma in Ureteropelvic Junction Obstruction: A Rare Case Report Spontaneous renal haemorrhage is a rare occurrence with potentially serious consequences. This presented case was an even rarer form of ureteropelvic obstruction (UPJO), which was spontaneous bleeding into the renal pelvis in a patient who was not previously investigated for UPJO. We presented a 17-year-old gentleman who presented with lower abdominal pain for one week and painless haematuria for two days. Initial computed tomography angiography (CTA) renal revealed haematoma with a grossly dilated pelvicalyceal system. The patient was initially treated conservatively. However, in the ward, he suddenly developed severe left-sided back pain, decreased haemoglobin level and persistent gross haematuria. Repeated CTA renal revealed worsening left renal haematoma with a grossly dilated pelvicalyceal system, and he was panned for nephrectomy. A review of the literature followed with a discussion of the case were done in this study.

Objectives: A history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH. Methodology: We conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD. Results: A history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029). Conclusion In patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.
Hypoglycemia ; Coronary Artery Disease ; Diabetes Mellitus, Type 2 ; C-Reactive Protein

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.

The purpose of this study was to evaluate the image quality and diagnostic accuracy of coronary computed tomography angiography (CCTA) using 640-slice scanner. Advancement of multidetector computed tomography (MDCT) technology with higher spatial, temporal resolution, and increasing detector array have improved the image quality and diagnostic accuracy of CCTA. A total of 25 patients (12 men and 13 women) underwent CCTA examination was chosen and data was acquired by 640-slice scanner. All 16 segments of coronary arteries were evaluated by two reviewers using a 4-likert scale for qualitative assessment. In quantitative assessment, the evaluation of 4 main coronary arteries were analysed in terms of signal intensity (SI), image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). All 25 patients with a mean age of 52.88 ± 14.75 years old and body mass index (BMI) of 24.24 ± 3.28 kg/m2 were analysed. In qualitative assessment, from the total of 400 segments, 379 segments (95%) had diagnostic value while 21 segments did not have diagnostic value, which means 5% artefact was detected. In quantitative assessment, there was no statistical differences in gender, race, and BMI (p>0.05). Overall evaluation showed that higher SI at the left main artery (LM) at 393.7 ± 47.19. Image noise was higher at right coronary artery (RCA) at 39.01 ± 13.97. SNR and CNR showed higher at left anterior descending (LAD) with 12.73 ± 5.17 and LM 9.14 ± 4.2, respectively. In conclusion, this study indicates that 640-slice MDCT has higher diagnostic value in CCTA examination with 95% vessel visibility with 5% artefact detection.

Introduction: A person’s childhood is an important period of growth, and also one’s most vulnerable, as one can be exposed to various pathologies, for example those that could affect the growth of one’s kidney. Asians are physiologically different from Caucasians, and the nomogram renal size obtained from a Western population (mostly of Caucasians) is not be suitable for representing Asian children. As such a nomogram on paediatric renal size derived from Malaysia is needed. Methods: A total of 109 (64 males and 45 females) aged 0-12 in Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) took part in this study. They underwent ultrasonography of both kidneys, and their demographic and anthropometric data were collected. The mean and standard deviations of the renal length and renal volume according to their age groups was calculated, and the final data was compared to the ones reported by Rosenbaum et al. (1984). Result: Body weight and Body Surface Area (BSA) of the children reported the strongest correlation with renal size. Significant differences were found between local and the data from Rosenbaum et al (1984). A nomogram on paediatric renal size based on children in PPUKM was then created. Discussion: Ultrasonography is regarded as the standard method for determining renal size. Body weight and BSA were both strongly correlated with renal size. It was shown that the widely used nomograms derived from data obtained from Caucasian was not suitable to represent the population of Malaysian children.

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

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

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.