MyMedR

INTRODUCTION: We aimed to compare the degree of bowel distension and image quality between pineapple juice and different mannitol concentrations, as well as patients' acceptance and side effects of these different magnetic resonant enterography (MRE) oral contrast agents.

MATERIALS AND METHODS: Seventy-five participants underwent MRE as an initial investigation or follow-up for inflammatory bowel disease. A systematic sampling method was used to divide the participants into three different groups: group 1 received 6.7% mannitol concentration, group 2 received 3.3% mannitol concentration and group 3 received pineapple juice as an oral contrast agent during their MRE examination. The degree of bowel distension on MRE images was assessed by a radiologist by measuring the bowel diameter from inner wall to inner wall at specified levels, while qualitative analysis was evaluated based on the presence of artefacts. All patients were asked to score their acceptance of the oral contrast and were asked about side effects such as diarrhoea, abdominal discomfort and vomiting.

RESULTS: All patients were able to completely ingest 1.5L of oral contrast. The mean diameter of bowel distension was 2.1cm in patients who received 6.7% mannitol concentration, 2.0cm in patients who received 3.3% mannitol concentration and 1.6 cm in patients who received pineapple juice. Twothirds of patients who received 6.7% mannitol and 3.3% mannitol solutions had good-quality MRE images, but 68% of patients who received pineapple juice had poor-quality MRE images. Twenty-four patients (96%) who received pineapple juice rated it as slightly acceptable and acceptable but only 12 patients (48%) who received 6.7% mannitol solution rated it as slightly acceptable and acceptable. Eighty-eight percent of patients who received 6.7% mannitol solution experienced at least one form of side effect as compared to 44% of patients who received 3.3% mannitol solution and 18% of patients who received pineapple juice.

CONCLUSION: Optimum small bowel distension and good image quality can be achieved using 3.3% mannitol concentration as an oral contrast agent. Increase in mannitol concentration does not result in significant improvement of small bowel distension or image quality but is instead related to poorer patient acceptance and increased side effects. Pineapple juice is more palatable than mannitol and produces satisfactory small bowel distension. However, the small bowel distension is less uniform when using pineapple juice with a considerable presence of artefacts. Mannitol, 3.3% concentration, is therefore recommended as an endoluminal contrast agent for bowel in MRE.

Fulltext Hearing loss in diving--a study amongst Navy divers

Zulkaflay AR, Saim L, Said H, Mukari SZ, Esa R

Med J Malaysia, 1996 Mar;51(1):103-8.

PMID: 10967988

Despite the commonly observed condition of middle and inner ear barotrauma among divers, there is little evidence of insidious and permanent development of sensorineural hearing loss associated with diving. An audiometric survey was performed on a group of 120 divers and 166 non divers from the Royal Malaysian Naval Base in Lumut, West Malaysia between July to December 1991. The results of this survey revealed that insidious development of high frequency sensorineural hearing loss may be associated with diving. At frequencies 4000, 6000 and 8000 Hz the divers had higher mean hearing levels than non divers and their hearing at those frequencies seemed to deteriorate faster. The etiology of this insidious hearing loss is multifactorial and may be related to inner ear barotrauma, decompression sickness or noise-induced deafness.

Fulltext Pneumatic reduction of intussusception using equipment readily available in the hospital

Zulfiqar MA, Noryati M, Hamzaini AH, Thambidorai CR

Med J Malaysia, 2006 Jun;61(2):199-203.

PMID: 16898311 MyJurnal

The purpose of this study was to determine the effectiveness of pneumatic reduction of intussusception using equipment readily available in the hospital. Twenty-two children aged between four months and four years had pneumatic reduction of intussusception. The device used was assembled using (i) a hand-held pump attached to a pressure gauge, and (ii) a 3-way Foley's balloon catheter. There was a 73% success rate and there were no complications. The device used was effective and safe for the pneumatic reduction of intussusception.

Fulltext Tumoral cystitis in children

Zulfiqar MA, Zaleha AM, Zulkifli I, Chia WY, Samad SA

Med J Malaysia, 1998 Sep;53(3):284-7.

PMID: 10968168

Three children aged 3-11 years had ultrasonography of the urinary tract for the investigation of dysuria and haematuria. A bladder mass was seen in these 3 children. One child had computed tomography scan, cystoscopy and bladder biopsy because rhabdomyosarcoma was considered. The biopsy revealed an inflammatory process. The urine culture of the other 2 children revealed E. coli. On ultrasonography, the inflammatory mass may appear homogeneously hypoechoic or may contain moderate level echoes. The mucosal surface of the mass may be smooth or lobulated. It is important to consider an infective cause for a bladder mass in children because computed tomography, cystoscopy and biopsy may be avoided.

Fulltext The treatment of neck lymphangioma with intralesional injection of bleomycin

Zulfiqar MA, Zaleha AM, Zakaria Z, Amin T

Med J Malaysia, 1999 Dec;54(4):478-81.

PMID: 11072465

We report our experience with intralesional injection of bleomycin in the treatment of neck lymphangioma. From May 1995 to April 1998, 11 patients aged between 6 to 22 months were treated with intralesional bleomycin injection. Ultrasonography and computed tomography were used to assess and select the cases suitable for sclerotherapy. Patients with lesions encasing the internal jugular vein and the carotid artery were chosen. With the patient under sedation and using ultrasound guidance, the cysts were aspirated and bleomycin was injected at a dose of 0.5 mg/kg body weight. The number of procedures varied from 1 to 4 over a period of 8 months to 1 year. Patients were initially followed-up 3 monthly, then 6 monthly and subsequently yearly. In 4 patients, the neck mass was no longer visible (excellent response). In 5 patients, the neck mass had reduced to a size (more than 50% reduction) that was cosmetically acceptable (good response). There were 2 failures (poor response). There were no complications. Our results suggest that intralesional injection of bleomycin can be effectively used to treat selected cases of neck lymphangiomas.

Fulltext The biopsy of nonpalpable breast lesions detected on mammography

Zulfiqar MA, Nair S, Lily M, Norizan MA

Med J Malaysia, 1999 Dec;54(4):471-7.

PMID: 11072464

This is a review of the positive biopsy rate of nonpalpable breast lesions detected on mammography. The histology of 130 hookwire excision biopsy from 1990 to 1995 and the cytology of 39 stereotactic fine needle aspiration cytology in 1995 were reviewed. The yearly positive biopsy rate of each procedure was determined. In 1990, the positive biopsy rate for hookwire excision biopsy was 15%, in 1991 20%, in 1992 11%, in 1993 17%, in 1994 33% and in 1995 39%. In 1995, the positive biopsy rate for stereotactic fine needle aspiration cytology was 21%. The positive biopsy rate for hookwire excision biopsy had improved from 15% in 1990 to 39% in 1995.

Fulltext The role of ductography in patients with nipple discharge

Zulfiqar MA, Nair S, Lily M, Norizan MA, Samad SA

Med J Malaysia, 1996 Dec;51(4):457-61.

PMID: 10968034

The main objective of this study is to illustrate the role of ductography in the management of nipple discharge. Thirty-six patients had ductography for the investigation of blood-stained or serous nipple discharge. The ductogram findings were reviewed. Ductography showed an intraductal lesion in 13 patients, duct ectasia in 16 and normal ducts in 7. Fourteen patients had surgery. Eight had preoperative ductography using a mixture of methylene blue and contrast media. Histology revealed 5 cases of duct papilloma, 2 cases of epithelial hyperplasia, 4 cases of fibrocystic change and 3 cases of duct ectasia. Twenty had follow-up without surgery and of these, the nipple discharge ceased in 11 patients. Two patients did not come for follow-up. Ductography has a significant role in the management of nipple discharge. Firstly, surgery might be averted in patients with normal ducts or duct ectasia on ductography. Secondly, intraductal methylene blue will demonstrate the abnormal ductal system to the surgeon and allow for a less radical surgery.

Fulltext Computed tomography (CT) of orbital pseudotumour

Zulfiqar A, Abdul-Samad S, Alias D, Norizan A

Med J Malaysia, 1993 Jun;48(2):160-5.

PMID: 8350791

Orbital pseudotumour is a non-specific inflammatory disease. Its highly variable clinical and radiographic presentation makes specific diagnosis difficult. This study on 31 proven cases of pseudotumour shows that unilateral involvement, retroorbital fat infiltration and enlargement of multiple extraocular muscles with involvement of the tendinous insertions are key computed tomography CT features which help to establish the diagnosis of orbital pseudotumour.

Fulltext Prebiopsy localization of nonpalpable breast lesions

Zulfiqar A, Param V, Meah FA, Nair S, Siti-Aishah MA, Norizan A

Med J Malaysia, 1993 Sep;48(3):317-24.

PMID: 8183145

Radiologically guided localization procedures are indicated pre-operatively when breast lesions are nonpalpable. The results of 42 percutaneous hookwire localizations over a period of 3 years are described. Of the total, 7 (17%) were found to be malignant. Biopsy was indicated by mammographically detected mass in 48%, by microcalcifications in 40% and by microcalcifications with an associated mass in 12%.

Synthesis and characterization of poly (methyl methacrylate)/SiO2 hybrid membranes: effect of solvents on thermal properties

Zulfikar MA, Mohammad AW

Med J Malaysia, 2004 May;59 Suppl B:141-2.

PMID: 15468858

Hybrid organic-inorganic membranes were fabricated using sol-gel technique using PMMA and TEOS with 80/20 (w/w) ratio at various solvents. The thin membrane films were then characterized using DSC and TGA. From DSC analysis, the Tg value of the PMMA moieties in hybrids membranes was in the order H-15-Toluene < Pure PMMA < H-15-THF < H-15-DMF. Furthermore, from TGA analysis it was found that the hybrid membranes have higher thermal stability compared to pure PMMA, and the type of solvents used play an important role in their degradation behavior.

Fulltext Anatomical variations of cystic artery: telescopic facts

Zubair M, Habib L, Mirza MR, Channa MA, Yousuf M, Quraishy MS

Med J Malaysia, 2012 Oct;67(5):494-6.

PMID: 23770866

Fulltext Spontaneous calf haematoma: case report

Zubaidah NH, Liew NC

Med J Malaysia, 2014 Feb;69(1):44-5.

PMID: 24814632 MyJurnal

Spontaneous calf haematoma is a rare condition and few case reports have been published in the English literature. Common conditions like deep vein thrombosis and traumatic gastrocnemius muscle tear need to be considered when a patient presents with unilateral calf swelling and tenderness. Ultrasound and Magnetic Resonance Imaging are essential for confirmation of diagnosis. The purpose of this paper is to report on a rare case of spontaneous calf hematoma and its diagnosis and management.

Fulltext Combined laparoscopic and thoracoscopic repair of a large traumatic diaphragmatic hernia: a case report

Zubaidah NH, Azuawarie A, Ong KW, Gee T

Med J Malaysia, 2015 Feb;70(1):57-8.

PMID: 26032535 MyJurnal

Traumatic diaphragmatic hernia is a well known complication of blunt trauma to the abdomen and thorax. In the acute setting, laparotomy is mandatory. In this current era, this condition can be managed with minimally invasive surgery. We hereby report a case of delayed large left diaphragmatic hernia that was repaired with a combination of laparoscopic and thoracoscopic approach.

Fulltext Hospital-acquired vancomycin-resistant enterococci: now appearing in Kuala Lumpur Hospital

Zubaidah AW, Ariza A, Azmi S

Med J Malaysia, 2006 Oct;61(4):487-9.

PMID: 17243529 MyJurnal

Hospital-acquired vancomycin-resistant enterococci (VRE) were first reported in the late 1980s and have since been an increasing problem worldwide. Kuala Lumpur Hospital thus far, to the best of our knowledge has been spared from this pathogen. We describe the first confirmed case of Enterococcus faecium exhibiting the van A phenotype in our hospital, in a patient with chronic renal failure who was successfully treated with linezolid. The microbiology laboratory plays an important role in the identification and detection of VRE.

Fulltext Necrotizing fasciitis

Zubaidah AW, Lim VKE

Med J Malaysia, 1996 Mar;51(1):134-6.

PMID: 10967993

A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.

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