MyMedR

Fulltext Do the majority of Malaysian women have dense breasts on mammogram?

Zulfiqar M, Rohazly I, Rahmah M

Biomed Imaging Interv J, 2011 Apr;7(2):e14.

PMID: 22291859 MyJurnal DOI: 10.2349/biij.7.2.e14

PURPOSE: TO DETERMINE: (i) the mammographic parenchymal patterns in Malaysian women and whether the breasts are dense on mammogram; (ii) the effect of age on breast density; (iii) the effect of parity on breast density; (iv) the difference in breast parenchymal patterns among the major races of women in Malaysia.
METHODS: This was a descriptive cross-sectional study of 1,784 patients (981 Malays, 571 Chinese, 214 Indians and 18 others) who had undergone mammography during the 1-year study period. Majority of women (41.7%) were aged between 51 and 60 years and majority (43%) had 3-4 children. The Tabar classification (Pattern I - V) was used to evaluate breast parenchymal patterns on mammogram. Tabar Pattern I was further divided into 3 sub-groups (Pattern IA, IB, and IC). The different patterns were then grouped into dense (IB, IC, IV, V) and not dense (IA, II, III) breasts. The SPSS package was used for statistical analysis.
RESULTS: Majority (59%) of Malaysian women had dense breasts (Pattern IB 29%, IC 20%, IV 5%, and V 5%) and 41% did not have dense breasts (Pattern IA 28%, II 6%, and III 7%). Age and parity were inversely related to breast density (p < 0.0001). Chinese women (65.7%) had the highest percentage of dense breasts (p = 0.69, odds ratio = 1.22), followed by the Indians (57.2%) and the Malays (50.5%).
CONCLUSION: Majority of women had dense breasts but Pattern IV, which has been associated with increased risk of breast cancer, was seen in only 5% of the women. The breast density reduced steadily with increasing age and parity. There was no statistically significant difference in breast density in the three main races.
KEYWORDS: Mammography; breast density; breast parenchymal patterns

Fulltext Echocontrast cystosonography versus micturating cystourethrography in the detection of vesicoureteric reflux

Faizah M, Kanaheswari Y, Thambidorai C, Zulfiqar M

Biomed Imaging Interv J, 2011 Jan-Mar;7(1):e7.

PMID: 21655116 MyJurnal DOI: 10.2349/biij.7.1.e7

To compare echocontrast cystosonography (ECS) using in-vivo agitated saline with fluoroscopic micturating cystourethrography (MCU) in the detection and grading of vesicoureteric reflux (VUR).

Fulltext Acute respiratory distress syndrome in a paediatric intensive care unit

Norrashidah AW, Azizi BH, Zulfiqar MA

Med J Malaysia, 1999 Jun;54(2):225-9.

PMID: 10972033

Acute respiratory distress syndrome (ARDS) is the final outcome of a common pathway of a variety of unrelated but massive insults to the lung. It is commonly seen in adults but also occurs in the paediatric age group. A prospective study was carried out to determine the incidence, predisposing conditions, clinical course and outcome of children with ARDS admitted to a paediatric intensive care unit (PICU). Six patients (aged 0.8 to 11 years) who fulfilled the strict criteria for ARDS were identified prospectively during a one year study period. The incidence was 1.7% of all PICU admission. The most common underlying conditions were septicemia and pneumonia. The mortality rate was 83%. Death most often occurred during the early phase of the disease. Treatment of ARDS included elimination of the cause of ARDS, early institution of mechanical ventilation with PEEP, prompt recognition and treatment of superimposed infection and careful management of additional organ failure.

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 Gas-containing liver abscesses: assessment by ultrasound (US) and computed tomography (CT)

Samad SA, Zulfiqar MA, Maimunah A

Med J Malaysia, 1993 Mar;48(1):33-9.

PMID: 8341170

Single gas-containing pyogenic liver abscesses in 11 patients were studied by ultrasound and computed tomography (CT). On ultrasound, all abscesses were predominantly echogenic compared to the normal liver parenchyma. The gas collections appeared as hyperreflective areas arranged in clusters associated with acoustic shadowing and ring-down artifacts. Ten abscesses (90%) had ill-defined margins on ultrasound, causing underestimation of their sizes in these patients. All abscesses were shown to be multiloculated and had clearly defined borders on CT, not appreciated or mistaken for multiplicity of abscesses on ultrasound. Ultrasound may be inadequate in the evaluation of gas-containing liver abscesses, as they have complex echotexture in addition to ring-down artifacts, acoustic shadows and poorly-defined margins; leading to underestimation of abscess size, difficulty in identifying loculations and erroneous interpretation of multiplicity of abscess cavities.

Fulltext Lymphangioma: Is intralesional bleomycin sclerotherapy effective?

Rozman Z, Thambidorai RR, Zaleha AM, Zakaria Z, Zulfiqar MA

Biomed Imaging Interv J, 2011 Jul-Sep;7(3):e18.

PMID: 22279495 MyJurnal DOI: 10.2349/biij.7.3.e18

This study aims to evaluate the effectiveness of intralesional bleomycin sclerotherapy in the treatment of lymphangioma in children and to determine the incidence of complications in the treatment.

Internal auditory canal stenosis in congenital sensorineural hearing loss

Sakina MS, Goh BS, Abdullah A, Zulfiqar MA, Saim L

Int J Pediatr Otorhinolaryngol, 2006 Dec;70(12):2093-7.

PMID: 16996619

Sensorineural hearing loss (SNHL) due to internal auditory canal (IAC) stenosis with hypoplasia of the cochleovestibular nerve is a rare disorder. The diagnosis of the IAC stenosis requires both high resolution computed tomography scan (HRCT) and magnetic resonance imaging (MRI).

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 Accuracy of ultrasound versus computed tomography urogram in detecting urinary tract calculi

Salinawati B, Hing EY, Fam XI, Zulfiqar MA

Med J Malaysia, 2015 Aug;70(4):238-42.

PMID: 26358021 MyJurnal

AIM: To determine the (i) sensitivity and specificity of ultrasound (USG) in the detection of urinary tract calculi, (ii) size of renal calculi detected on USG, and (iii) size of renal calculi not seen on USG but detected on computed tomography urogram (CTU).
METHODS: A total of 201 patients' USG and CTU were compared retrospectively for the presence of calculi. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of USG were calculated with CTU as the gold standard.
RESULTS: From the 201 sets of data collected, 59 calculi were detected on both USG and CTU. The sensitivity and specificity of renal calculi detection on USG were 53% and 85% respectively. The mean size of the renal calculus detected on USG was 7.6 mm ± 4.1 mm and the mean size of the renal calculus not visualised on USG but detected on CTU was 4 mm ± 2.4 mm. The sensitivity and specificity of ureteric calculi detection on USG were 12% and 97% respectively. The sensitivity and specificity of urinary bladder calculi detection on USG were 20% and 100% respectively.
CONCLUSION: This study showed that the accuracy of US in detecting renal, ureteric and urinary bladder calculi were 67%, 80% and 98% respectively.
Study site: Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur

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.

Predictors of failure of nasal continuous positive airway pressure in treatment of preterm infants with respiratory distress syndrome

Boo NY, Zuraidah AL, Lim NL, Zulfiqar MA

J Trop Pediatr, 2000 Jun;46(3):172-5.

PMID: 10893920

A case-control study was carried out on 97 consecutive preterm (< 37 weeks) infants to determine predictors associated with failure of nasal continuous positive airway pressure (CPAP) in the treatment of respiratory distress syndrome (RDS). Logistic regression analysis showed that only three risk factors were significantly associated with failed CPAP. These were: moderate or severe RDS (odds ratio: 5.9; 95 per cent confidence interval (CI): 2.2-16.0); septicemia during CPAP therapy (OR: 8.8; 95 per cent: CI 1.5-50.7); and pneumothorax during CPAP therapy (odds ratio: 6.9; 95 per cent: CI 1.1-41.7).

Preoperative high resolution CT and MR imaging in cochlear implantation

Abdullah A, Mahmud MR, Maimunah A, Zulfiqar MA, Saim L, Mazlan R

Ann Acad Med Singap, 2003 Jul;32(4):442-5.

PMID: 12968546

INTRODUCTION: Accurate preoperative imaging of the temporal bone in patients receiving cochlear implants is important. High resolution computed tomography (HRCT) and magnetic resonance (MR) imaging are the 2 preoperative imaging modalities that provide critical information on abnormalities of the otic capsule, pneumatisation of the mastoid, middle ear abnormalities, cochlear ducts patency and presence of cochlear nerve.

MATERIALS AND METHODS: The HRCT and MR imaging in 46 cochlear implant patients in our department were reviewed.

RESULTS: Majority of our patients [34 patients (73.9%)] showed normal HRCT of the temporal bone; 5 (10.9%) patients had labyrinthitis ossificans, 2 (4.3%) had Mondini's abnormality and 2 (4.3%) had middle ear effusion. One patient each had high jugular bulb, hypoplasia of the internal auditory canal and single cochlear cavity, respectively.

CONCLUSION: The above findings contribute significantly to our surgical decisions regarding candidacy for surgery, side selection and surgical technique in cochlear implantation.

Fulltext Ultrasound guided percutaneous biopsies of suspected mediastinal lesions

Samad SA, Sharifah NA, Zulfiqar MA, Maimunah A, Yahya A, Zainudin W

Med J Malaysia, 1993 Dec;48(4):421-6.

PMID: 8183166

Realtime ultrasonography with general purpose sector transducer was used to guide 87 percutaneous biopsies on 82 patients with lesions suspected to be mediastinal masses on plain chest radiographs. In seven patients who had dyspnea the biopsies were done in erect or semi-erect sitting positions. Definitive diagnosis was obtained from 66 lesions (80.5%) where 46 (70.0%) were mediastinal and the remaining 20 lesions (30.0%) arising from the lung. Of the 46 mediastinal lesions where specific diagnosis were made, 42 (91.0%) were anterior and four (0.9%) posterior mediastinal lesions. The majority of these anterior mediastinal masses were lymphomatous nodes followed by germ cell tumours whereas all four posterior mediastinal masses were neurogenic. Of the lung lesions, 19 were primary malignancies. The remaining lung lesion which was located posteriorly was cryptococcus infection. One patient developed massive hemothorax, but subsequently recovered. No significant complications were encountered in the remaining patients. Surgery was carried on 11 patients. There is correlation between definitive diagnosis from percutaneous biopsy and final diagnosis after surgery in 80% of patients. It is proposed that all percutaneous biopsies for thoracic masses which abut the chest wall and cause mediastinal widening on a plain chest radiograph be guided by ultrasound. It can be effectively accomplished with ease and safety even without the use of dedicated biopsy ultrasound probes or biopsy attachments, and on patients in erect or semi-erect positions.

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 Malignant pancreatic carcinoid tumour

Zarina AL, Hamidah A, Zulkifli SZ, Zulfiqar MA, Jamal R

Singapore Med J, 2007 Dec;48(12):e320-2.

PMID: 18043827

Pancreatic carcinoid tumours are rare, particularly within the paediatric population. The clinical presentation is largely dependent on the functionality of the tumour. Although the tumour is generally slow-growing, surgical resection is still the mainstay of curative treatment. Morbidity is, however, significantly contributed by secretion of excess hormones; in view of this, biotherapy is an important treatment strategy. Octreotide, a somatostatin analogue, has been shown to be successful in both symptomatic control and stability of tumour progression. We report a 12-year-old girl, who presented with hypertensive crisis, and showed good response to a combination of chemotherapy and octreotide.

Intramedullary spinal cord abscess: The result of a missed congenital dermal sinus

Kanaheswari Y, Lai C, Raja Lope RJ, Azizi AB, Zulfiqar MA

J Paediatr Child Health, 2015 Feb;51(2):223-5.

PMID: 25099316 DOI: 10.1111/jpc.12707

Congenital dermal sinus (CDS) and occult spinal dysraphism are suspected when a cutaneous marker overlies the spine of a newborn. CDS can have the appearance of a simple dimple and occur within the gluteal cleft without any skin markers. CDS are the commonest cause of intramedullary spinal cord abscess.

Fulltext Contrast enhanced voiding urosonography (ce-VUS) as a radiation-free technique in the diagnosis of vesicoureteric reflux: Our early experience

Faizah MZ, Hamzaini AH, Kanaheswari Y, Dayang A AA, Zulfiqar MA

Med J Malaysia, 2015 Oct;70(5):269-72.

PMID: 26556113 MyJurnal

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 ce- VUS 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.

Fulltext Comparison on the use of semi-automated and automated core biopsy needle in ultrasound guided breast biopsy

Sridharan R, Yunos SM, Aziz S, Hussain RI, Alhabshi SM, Suria Hayati MP, et al.

Med J Malaysia, 2015 Dec;70(6):326-33.

PMID: 26988204 MyJurnal

OBJECTIVE: The aim of this study was to compare the use of semi-automated (Medax Velox 2; Poggio Rusco, Italy) and automated (Bard Magnum Biopsy Instrument; Covington, GA, USA) core biopsy needles, for ultrasound guided breast biopsy.
MATERIALS AND METHODS: A 14G semi-automatic spring loaded core biopsy needle with a 22-mm-throw (Medax Velox 2; Poggio Rusco, Italy) and 14-gauge automated needle device with a 22-mm-throw biopsy gun (Bard-Magnum Biopsy Instrument, Covington, GA, USA) were used for breast biopsies under ultrasound guidance on alternate months during the study period between July 2009 and May 2011. One hundred and sixty lesions were biopsied and specimens were sent for histological evaluation.
RESULTS: The automated needle obtained a higher number of histology reports at 84% (67/80) as compared with the semiautomated needle at 60% (48/80) (Fisher exact test, p value=0.023). Inadequate samples with the automated needle were much less at 9% (7/60) than with the semiautomated needle at 23% (18/60) (Fisher exact test, p value=0.028). The semi-automated needle showed slightly less fragmented samples. However, the number of fragmented samples with definitive diagnosis was slightly higher with the automated compared with the semiautomated needle, at 16% (13/80) and 13% (10/80) respectively. Compared with histology of 29 lesions that were excised, the semi-automated needle had higher sensitivity (100%) but lower specificity (75%) and accuracy (90%) compared with the automated needle (88% sensitivity, 100% specificity, 95% accuracy).
CONCLUSION: Definitive diagnosis from the study samples slightly favours the use of automated core biopsy needle as compared to semi-automated core biopsy needle.
Study site: Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur

Fulltext Renal doppler assessment in differentiating obstructive from non-obstructive hydronephrosis in children

Nadzri M, Hing EY, Hamzaini AH, Faizah MZ, AbAziz A, Kanaheswari Y, et al.

Med J Malaysia, 2015 Dec;70(6):346-50.

PMID: 26988207 MyJurnal

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.
Study site: Universiti Kebangsaan Malaysia
Medical Centre, Kuala Lumpur, Malaysia

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