Sultan Ismail Hospital

Johor Bahru, Malaysia

Sultan Ismail Hospital

Johor Bahru, Malaysia
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Hashim S.,University of Technology Malaysia | Hashim S.,Sultan Ismail Hospital | Omar S.S.C.,University of Technology Malaysia | Ibrahim S.A.,University of Technology Malaysia | And 6 more authors.
Radiation Physics and Chemistry | Year: 2015

We describe the efforts of finding a new thermoluminescent (TL) media using pure silica flat optical fiber (FF). The present study investigates the dose response, sensitivity, minimum detectable dose and glow curve of FF subjected to 9. MeV electron irradiations with various dose ranges from 0 Gy to 2.5 Gy. The above-mentioned TL properties of the FF are compared with commercially available TLD-100 rods. The TL measurements of the TL media exhibit a linear dose response over the delivered dose using a linear accelerator. We found that the sensitivity of TLD-100 is markedly 6 times greater than that of FF optical fiber. The minimum detectable dose was found to be 0.09 mGy for TLD-100 and 8.22 mGy for FF. Our work may contribute towards the development of a new dosimeter for personal monitoring purposes. © 2014 Elsevier Ltd.


Khoo J.-J.,Monash University | Ng C.-S.,Sultanah Aminah Hospital | Sabaratnam S.,Monash University | Arulanantham S.,Sultan Ismail Hospital
Asian Pacific Journal of Cancer Prevention | Year: 2016

Background: Examination of sentinel lymph node (SLN) biopsies provides accurate nodal staging for breast cancer and plays a key role in patient management. Procurement of SLNs and the methods used to process specimens are equally important. Increasing the level of detail in histopathological examination of SLNs increases detection of metastatic tumours but will also increase the burden of busy laboratories and thus may not be carried out routinely. Recommendation of a reasonable standard in SLN examination is required to ensure high sensitivity of results while maintaining a manageable practice workload. Materials and Methods: Twenty-four patients with clinically node-negative breast cancer were recruited. Combined radiotracer and blue dye methods were used for identification of SLNs. The nodes were thinly sliced and embedded. Serial sectioning and immunohistochemical (IHC) staining against AE1/AE3 were performed if initial H&E sections of the blocks were negative. Results: SLNs were successfully identified in all patients. Ten cases had nodal metastases with 7 detected in SLNs and 3 detected only in axillary nodes (false negative rate, FNR=30%). Some 5 out of 7 metastatic lesions in the SLNs (71.4%) were detected in initial sections of the thinly sliced tissue. Serial sectioning detected the remaining two cases with either micrometastases or isolated tumour cells (ITC). Conclusions: Thin slicing of tissue to 3-5mm thickness and serial sectioning improved the detection of micro and macro-metastases but the additional burden of serial sectioning gave low yield of micrometastases or ITC and may not be cost effective. IHC validation did not further increase sensitivity of detection. Therefore its use should only be limited to confirmation of suspicious lesions. False negative cases where SLNs were not involved could be due to skipped metastases to non-sentinel nodes or poor technique during procurement, resulting in missed detection of actual SLNs.


PubMed | Manipal University India, Sultan Ismail Hospital and University of Alabama at Birmingham
Type: Journal Article | Journal: Asian Pacific journal of tropical medicine | Year: 2016

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melioidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.


Hoo J.Y.,Sultan Ismail Hospital | Sathasivam H.P.,Sultan Ismail Hospital | Lau S.H.,Institute for Medical Research | Saw C.L.,Air Itam Clinic
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology | Year: 2016

Trigeminal neuralgia (TGN) is an extremely painful condition affecting the face. Although the precise mechanism of TGN is still incompletely understood, it is believed that the majority of patients have some form of compression of the nerve caused by blood vessels. However, a proportion of patients may have TGN caused by involvement of the nerve by space occupying lesions such as tumours. Six cases of TGN secondary to tumours that involved the trigeminal nerve are presented. The importance of thorough clinical examination as well as diagnostic imaging in the assessment and management of TGN patients is discussed. © 2016 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI.


PubMed | Penang Health Services, Sultan Ismail Hospital, Raja Perempuan Zainab II Hospital, Hospital Raja Permaisuri Bainun and 4 more.
Type: Journal Article | Journal: Oral surgery, oral medicine, oral pathology and oral radiology | Year: 2016

This study was performed to obtain the clinicodemographic data regarding patients with trigeminal neuralgia (TN) treated at oral-maxillofacial medicine clinics, as there is a paucity of such information in the Asian setting.Retrospective multicenter study involving clinicodemographic information of 320 patients with TN diagnosed between 2001 and 2012 at eight regional oral-maxillofacial medicine clinics and followed up for at least 6months. Statistical tests were performed to assess the associations among the clinicodemographic factors.TN was mostly diagnosed during the seventh and sixth decades of life, with a median of 58.2years (interquartile range=13.0). Females were more commonly affected (61.6%). TN affected the right side more frequently, and the mandibular branch was most commonly involved (58.5%). Carbamazepine was the first-line drug of choice (87.5%).Asian patients with TN exhibited features similar to those in Caucasian patients except for the increased affliction of the mandibular division.


Aboud H.,University of Technology Malaysia | Aboud H.,University of Baghdad | Wagiran H.,University of Technology Malaysia | Hussin R.,University of Technology Malaysia | And 3 more authors.
Applied Radiation and Isotopes | Year: 2014

Characteristics of lithium potassium borate glasses with various copper concentrations are reported. The glasses were prepared by the melt quenching method and irradiated with photons to doses in the 0.5-4.0. Gy range. Glowing curves, dose response curves, reproducibility of the response, dose threshold, thermal fading and optical bleaching were studied. © 2014 Elsevier Ltd.


Ramli N.,University of Malaya | Khairy A.M.,Sultan Ismail Hospital | Seow P.,University of Malaya | Tan L.K.,University of Malaya | And 3 more authors.
European Radiology | Year: 2016

Objectives: We evaluated the feasibility of using chemical shift gradient-echo (GE) in- and opposed-phase (IOP) imaging to grade glioma. Methods: A phantom study was performed to investigate the correlation of 1H MRS-visible lipids with the signal loss ratio (SLR) obtained using IOP imaging. A cross-sectional study approved by the institutional review board was carried out in 22 patients with different glioma grades. The patients underwent scanning using IOP imaging and single-voxel spectroscopy (SVS) using 3T MRI. The brain spectra acquisitions from solid and cystic components were obtained and correlated with the SLR for different grades. Results: The phantom study showed a positive linear correlation between lipid quantification at 0.9 parts per million (ppm) and 1.3 ppm with SLR (r = 0.79–0.99, p < 0.05). In the clinical study, we found that SLR at the solid portions was the best measure for differentiating glioma grades using optimal cut-points of 0.064 and 0.086 with classification probabilities for grade II (SII = 1), grade III (SIII = 0.50) and grade IV (SIV = 0.89). Conclusions: The results underscore the lipid quantification differences in grades of glioma and provide a more comprehensive characterization by using SLR in chemical shift GE IOP imaging. SLR in IOP sequence demonstrates good performance in glioma grading. Key Points: • Strong correlation was seen between lipid concentration and SLR obtained using IOP • IOP sequence demonstrates significant differences in signal loss within the glioma grades • SLR at solid tumour portions was the best measure for differentiation • This sequence is applicable in a research capacity for glioma staging armamentarium © 2015, The Author(s).


Park J.-Y.,Konkuk University | Chung S.W.,Konkuk University | Hassan Z.,Sultan Ismail Hospital | Bang J.-Y.,Konkuk University | Oh K.-S.,Konkuk University
American Journal of Sports Medicine | Year: 2014

Background: In spite of the high prevalence of shoulder stiffness during rotator cuff repair, optimal management remains unclear. Purpose: To identify the effect of capsular release during rotator cuff repair on the outcomes of patients with both shoulder stiffness and a rotator cuff tear, based on subgroup analyses. Study Design: Cohort study; Level of evidence, 3. Methods: Forty-nine consecutive patients (mean age, 61.5 ± 8.3 years) were enrolled who underwent arthroscopic repair of a small- to large-sized full-thickness rotator cuff tear and manipulation for concomitant shoulder stiffness (passive forward flexion≤120°, external rotation at the side≤45°). The first 21 consecutive patients underwent manipulation alone to treat stiffness; the second 28 consecutive patients underwent capsular release with manipulation. Among the 49 patients, 25 showed severe stiffness (forward flexion≤100°, external rotation at the side ≤30°; 11 in the first series and 14 in the second series), and 15 had diabetes mellitus (30.6%; 6 in the first series and 9 in the second series). Shoulder range of motion was measured 6 weeks, 3 months, 6 months, and 1 year postoperatively and at final follow-up visit. Simultaneously, functional outcome was evaluated by visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and muscle strength ratio (involved/uninvolved), and cuff integrity was assessed ultrasonographically at least 1 year postoperatively. Results: All range of motion measurements, functional scores, and muscle strength ratios significantly improved postoperatively regardless of the treatment method of stiffness. No outcome measure differed significantly between patients who did and did not undergo capsular release, regardless of the severity of stiffness, except for a temporary improvement in external rotation at side 3 months postoperatively in favor of those who underwent capsular release in cases with severe stiffness. Among patients with diabetes mellitus however, those who underwent capsular release showed greater improvement in forward flexion after 3 months and 1 year and in external rotation at the side for all time points (all P < .05), except for 6 weeks postoperatively; these patients also had a significantly higher final American Shoulder and Elbow Surgeons score (P = .03). Of 21 patients who underwent manipulation alone and of 28 who underwent capsular release and manipulation, 2 and 1 developed retears, respectively. Conclusion: Both manipulation and capsular release with manipulation significantly improved range of motion and produced satisfactory functional outcomes. The outcomes did not differ between treatment methods for stiffness regardless of the severity of stiffness. In patients with diabetes mellitus however, capsular release at the time of rotator cuff repair seems to be beneficial, especially for external rotation and final postoperative function. © 2014 The Author(s).


PubMed | Sultan Ismail Hospital and University of Malaya
Type: Journal Article | Journal: European radiology | Year: 2016

We evaluated the feasibility of using chemical shift gradient-echo (GE) in- and opposed-phase (IOP) imaging to grade glioma.A phantom study was performed to investigate the correlation of (1)H MRS-visible lipids with the signal loss ratio (SLR) obtained using IOP imaging. A cross-sectional study approved by the institutional review board was carried out in 22 patients with different glioma grades. The patients underwent scanning using IOP imaging and single-voxel spectroscopy (SVS) using 3T MRI. The brain spectra acquisitions from solid and cystic components were obtained and correlated with the SLR for different grades.The phantom study showed a positive linear correlation between lipid quantification at 0.9 parts per million (ppm) and 1.3ppm with SLR (r=0.79-0.99, p<0.05). In the clinical study, we found that SLR at the solid portions was the best measure for differentiating glioma grades using optimal cut-points of 0.064 and 0.086 with classification probabilities for grade II (SII=1), grade III (SIII=0.50) and grade IV (SIV=0.89).The results underscore the lipid quantification differences in grades of glioma and provide a more comprehensive characterization by using SLR in chemical shift GE IOP imaging. SLR in IOP sequence demonstrates good performance in glioma grading. Strong correlation was seen between lipid concentration and SLR obtained using IOP IOP sequence demonstrates significant differences in signal loss within the glioma grades SLR at solid tumour portions was the best measure for differentiation This sequence is applicable in a research capacity for glioma staging armamentarium.


PubMed | Sarawak General Hospital, Sultan Ismail Hospital, Cancer Research Initiatives Foundation, Paediatrics Institute and 2 more.
Type: Journal Article | Journal: Clinical genetics | Year: 2015

Type of cancer and age of onset in individuals with inherited aberrations in the tumour suppressor gene TP53 are variable, possibly influenced by genetic modifiers and different environmental exposure. Since 2009, the modified Chompret criteria (MCC) have been used to identify individuals for TP53 mutation screening. Using the TP53 mutation database maintained by the International Agency for Research on Cancer (IARC), we investigated if the MCC, mainly developed for a Caucasian population, was also applicable in Asia. We identified several differences in Asian families compared with similar Caucasian cohorts, suggesting that identification and management of Li-Fraumeni syndrome in Asia do not completely mirror that of North America and Western Europe. Early gastric cancer (<40years) may be considered a new addition to the MCC especially for Asian families.

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