Introduction: Constipation is affecting a quarter of human population at any one time in all age groups. However, a proper gamma scintigraphic study of whole GI transit is rarely performed in Malaysia due to the lack of suitable radiopharmaceutical. Hence, this study was taken to develop a suitable radiotracer formulation for gamma scintigraphy study of whole gastric-intestinal transit. Methods: The biocompatible polystyrene (PS) incorporated with 152Sm2O3 (5%, w/v) will be used to synthesize the radiotracer. The 152Sm-labelled PS particles was neutron activated to 153Sm in a nuclear reactor for 5 minutes. Characterization of the physicochemical properties, gamma spectrometry and in-vitro radiolabeling studies in simulated gastric fluid (SGF) and simulated intestinal fluid (SIF) were carried out to study the properties and stability of the radiotracer before and after neutron activation. Results: Scanning electron microscope (SEM) and particle size analysis showed that size, shape and surface morphology of the particles remained after neutron activation. The synthesized 153Sm-labelled PS radiotracer (100 mg) particles achieved an activity of 3.7 MBq after 46 hrs. As indicated by the gamma spectrometry result, there is no long half-life radioimpuirties present in the samples. The 153Sm-labelled PS particles achieved radiolabeling efficiency of more than 95% in both SGF and SIF over 72 hrs. Conclusions: A 153Sm-labelled radiotracer particles formulation has been successfully developed from biocompatible PS. The proposed formulation has the advantage of cheaper, easier to be produced and reduced radiation exposure to staff. Further studies are required to validate the in-vivo performance of 153Sm-labelled formulation for assessing GI motility and transit in clinical use.
During endoscopic sinus and skull base surgeries, surgical landmarks are routinely used to guide surgeons navigating in the narrow corridor of the sinonasal region. Risk of complications is higher in difficult cases when there is excessive bleeding or alteration of the normal anatomical landmarks by tumour. An additional landmark is advantageous to prevent complications and serves as a guide. We present a case of supreme turbinate found incidentally during an endoscopic transsphenoidal surgery. Not much is known about the role of supreme turbinate. When it is present, the sphenoid ostium is located medial to its posteroinferior attachment, and behind its vertical part. Hence, the identification of this structure serves as an additional landmark besides superior turbinate during surgery.
Sinonasal tumors in children are rare and difficult to manage. These tumors can be broadly categorized into congenital or acquired and benign or malignant. The tumors mainly arise from the mucosa, cartilage, or bone of the nasal cavity and may occupy areas of the nasal septum, turbinates, osteomeatal complex, sinuses, and nasopharynx. The management of pediatric sinonasal tumors is challenging, especially in cases of malignancy. Malignant tumors pose a treatment dilemma because most such tumors tend to be aggressive and carry a poor prognosis. Multiple complications associated with the primary disease or treatment may occur, and such complications need to be fully addressed to provide optimal care. In most cases, a multidisciplinary team approach will offer the best possible outcome for children with sinonasal tumors.
Nasal septal surgery among children remains controversial because of its adverse effect on craniofacial development. Recent studies, however, have demonstrated that early nasal septal correction prevents the midfacial and nasal growth deformity that is the inevitable consequence of nasal septal abnormality. Nasal septal surgery in children has been reported to lead to significant improvement in quality of life. We reviewed the existing literature to evaluate the outcomes of pediatric nasal septal surgery.
The application of meta-heuristic algorithms for t-way testing has recently become prevalent. Consequently, many useful meta-heuristic algorithms have been developed on the basis of the implementation of t-way strategies (where t indicates the interaction strength). Mixed results have been reported in the literature to highlight the fact that no single strategy appears to be superior compared with other configurations. The hybridization of two or more algorithms can enhance the overall search capabilities, that is, by compensating the limitation of one algorithm with the strength of others. Thus, hybrid variants of the flower pollination algorithm (FPA) are proposed in the current work. Four hybrid variants of FPA are considered by combining FPA with other algorithmic components. The experimental results demonstrate that FPA hybrids overcome the problems of slow convergence in the original FPA and offers statistically superior performance compared with existing t-way strategies in terms of test suite size.
Primary bone lymphoma is an uncommon tumour accounting for approximately 4-5% of extra nodal lymphoma and less than 1% of all Non-Hodgkin's lymphoma. The radiographic appearance of primary bone lymphoma is variable. As lesions frequently resemble other disease processes namely chronic osteomyelitis and metastases, further imaging evaluation and histopathological examination allow early identification for appropriate treatment. The authors present a case of anaplastic large cell lymphoma of bone presenting with multifocal osseus involvement.
The accuracy and the efficacy of radiological diagnosis depend, to a large extent, on the conditions under which radiographs and images are viewed. This mainly involves the luminance of the display devices and the ambient room illumination. We report a perceptual study to investigate the relationship between detectability and monitor luminance as well as ambient illuminance. A statistical test pattern was used in this study, and the test pattern was developed using Microsoft® Visual Basic 6. The test pattern contained a set of randomised contrast detail objects, that is, disks of different diameters (0.7, 1.0, 1.4, and 2.0 mm) and contrasts against a black background (2.7, 3.9, 5.5, and 7.8%), simulating lesions in digital images. The receiver operating characteristic (ROC) analysis was used in this study. The results indicated that a set of optimal viewing conditions exists and that it has a significant effect on detectability performance.
Acquired intra-abdominal arteriovenous fistulas (AVFs) are a rare disorder where the communication most commonly occurs between abdominal aorta and inferior vena cava. Ilio-iliac AVF has been reported previously, but is exceedingly rare. We present a case of spontaneous ilio-iliac AVF in an elderly woman who presented with symptoms of right heart failure where the diagnosis was not considered. The computed tomographic (CT) and angiographic features are described. The current status of management as well as a review of the literature is also presented.
Sinonasal tumors may grow to considerable size before presentation and in view of their relation to the base of skull, orbit, cranial nerves and vital vessels; a precise diagnostic and therapeutic planning is needed to achieve the optimal results. We report a case who presented with unilateral nasal blockage, rhinorrhea and episodes of epistaxis which diagnosed as sinonasal inverted papilloma and angiofibroma.
A rare case of diffuse malignant peritoneal mesothelioma in a 71 year-old Malay man with no previous history of asbestos or radiation exposure is described. The clinical manifestation was a large abdominal mass. At laparotomy he was found to be in the advanced stage of the disease. The tumour was not resectable and patient was sent home. He gradually deteriorated and died three months after diagnosis was made. The magnetic resonance imaging (MRI) features of peritoneal mesothelioma which has not been previously reported are described.
We present a case of rare pitfall in the diagnosis of an oesophageal foreign body due to the calcified vertical plate of the cricoid to highlight the need to be aware of this entity to avoid unnecessary morbidity.
Introduction: Hepatic radioembolization is a minimally invasive procedure involving intrarterial administration of radioembolic microspheres for the treatment of liver tumours. In this study, a biocompatible polystyrene (PS) microspheres formulation containing radioactive Samarium-153 (153Sm) was synthesized and tested. The 153Sm emits both diagnostic gamma energy and therapeutic beta radiation, renders the synthesized microspheres an ideal theranostic radioembolic agent for hepatic radioembolization. Methods: First, the 152Sm2O3 (20 – 50%, w/v) was encapsulated in PS microspheres using solid-in-oil-in-water solvent evaporation method. The 152Sm-labelled PS microspheres were then activated to 153Sm (Eβmax = 807.6 keV, half-life = 46.3 hours) via 152Sm (n,γ) 153Sm reaction in a nuclear reactor with a neutron flux of 2.0 x 1012 n.cm-2.s-1. Physicochemical characterization, gamma spectroscopy and in-vitro radiolabeling studies were carried out to study the properties and stability of the microspheres before and after neutron activation. Results: The 153Sm -labelled PS microspheres achieved a nominal activity of 4.0 GBq.g-1 after 6 hours of neutron activation. Scanning electron microscope (SEM) and particle size analysis show that the microspheres remained spherical with diameters within 15 – 60 μm after neutron activation. No long half-life radioimpurities were found in the samples as revealed by the gamma spectroscopy results. The 153Sm-labelled PS microspheres achieved radiolabeling efficiency of more than 95% in saline and blood plasma over 480 hours. Conclusion: A biocompatible 153Sm-radiolabelled PS microspheres formulation has been successfully developed. The formulation achieved desirable properties for theranostic treatment of liver tumours. The formulation is relatively cheaper, easier to be produced and more readily available.
The therapeutic goals of the treatment of allergic rhinitis (AR) and chronic rhinosinusitis (CRS) are symptom relief, avoiding complications, and improving quality of life. In the treatment of AR and CRS, several limitations of currently prescribed medicines have been identified. Antihistamine administration (both oral and topical) together with intranasal corticosteroids bring relief to the majority of patients, but their dependency on the medications and a necessity to maintain strict compliance with regular medication regimes pose a challenge. Immunotherapeutic agents are an option in some patients, but polysensitized patients, the risk of anaphylaxis, and the need for daily administration for years are limiting it from becoming the main therapy modality. Immunotherapy in any form requires commitment by the patient, which renders adherence and compliance issues particularly relevant. The procedure involved are generally time-consuming and entail an associated risk of severe adverse reactions. The use of biologics could overcome the limitations of other therapeutic modalities. They could be used as a monotherapy or combined with pre-existing medications. The benefits of targeted therapy include less adverse effects and optimal efficacy. The aim of the present review was to investigate the collective literature to date pertaining to the role of biologics in managing children with AR and CRS.