Motion corrected LV quantification based on 3D modelling for improved functional assessment in cardiac MRI.

Cine MRI is a clinical reference standard for the quantitative assessment of cardiac function, but reproducibility is confounded by motion artefacts. We explore the feasibility of a motion corrected 3D left ventricle (LV) quantification method, incorporating multislice image registration into the 3D model reconstruction, to improve reproducibility of 3D LV functional quantification. Multi-breath-hold short-axis and radial long-axis images were acquired from 10 patients and 10 healthy subjects. The proposed framework reduced misalignment between slices to subpixel accuracy (2.88 to 1.21 mm), and improved interstudy reproducibility for 5 important clinical functional measures, i.e. end-diastolic volume, end-systolic volume, ejection fraction, myocardial mass and 3D-sphericity index, as reflected in a reduction in the sample size required to detect statistically significant cardiac changes: a reduction of 21-66%. Our investigation on the optimum registration parameters, including both cardiac time frames and number of long-axis (LA) slices, suggested that a single time frame is adequate for motion correction whereas integrating more LA slices can improve registration and model reconstruction accuracy for improved functional quantification especially on datasets with severe motion artefacts.

Lipids and coronary heart disease in Asia.

In Western countries, it has been shown that coronary heart disease (CHD) is related to high serum total cholesterol (TC) levels. In less developed continents such as Asia and Africa, serum lipid levels are low and CHD incidence is much lower as compared with Western countries. With growing urbanization and industrialization in Asia, it has been shown that there is a concomitant rise in the level of serum TC and with it a rise in CHD. In all the Asian countries, serum TC levels are also higher in the urban compared with the rural population. Singapore, the only Asian country which is 100% urbanized since 1980, showed a rise of serum TC similar to that seen in the US and UK from the 1950s to the 1980s followed thereafter by a fall. This is reflected in the trend (rise followed by a fall) of CHD morbidity and mortality as well. In spite of a declining trend in serum TC level, CHD morbidity and mortality are still high in Singapore and comparable to the Western countries. The rest of the Asian countries show a different pattern from Singapore. In general, there is still a rising trend in serum TC level and in CHD mortality in most Asian countries. However, Japan is considered an exception in having a decreasing CHD mortality in spite of an increasing trend in serum TC. This may be attributed to a better control of other CHD risk factors such as hypertension and smoking. The rising trend in serum TC level remains a cause for concern, as this will emerge as a major problem for CHD morbidity and mortality in the future.

Blood pressure, body mass index, heart rate and levels of blood cholesterol and glucose of volunteers during National Heart Weeks, 1995-1997.

The paper presents the results of a health screening programme conducted in 10 major centers in Malaysia--Kuala Lumpur, Penang, Ipoh, Johor Bahru, Alor Star, Kuala Terengganu, Malacca, Kota Bahru, Kuching and Kota Kinabalu during the National Heart Weeks, 1995-1997. There were 6,858 participants of both sexes aged between 6 years to 81 years old. The parameters involved in the screening programme were body mass index, blood pressure, heart rate, cholesterol and glucose. The following are the results of the study:- 1. The mean and standard deviation for the body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), total cholesterol (TC) and non fasting (random) blood glucose (GL) of the volunteers studied were 24.3 +/- 4.0 kg/m2, 128.3 +/- 21.1 mmHg, 79.6 +/- 11.9 mmHg, 77.2 +/- 12.1 bpm, 5.33 +/- 1.37 mmol/l and 5.11 +/- 1.97 mmol/l respectively. 2. There was a rising trend for BMI, SBP, DBP, TC and GL with age. The HR was higher in the younger age group of those below 20 years. Males tended to have higher mean values than females except for HR which was similar in both sexes. 3. The Malays, Chinese and Indians seemed to have closely similar mean values for SBP, DBP and HR but the Indians possessed the highest BMI (25.62 +/- 3.90 kg/m2), TC (5.61 +/- 1.48 mmol/l) and GL (5.41 +/- 2.43 mmol/l) among the three major ethnic groups. While the Ibans had highest TC (6.07 + 1.09 mmol/l), their GL level was the lowest (4.76 +/- 1.15 mmol/l). The Kadazans had the lowest TC level (4.94 +/- 1.39 mmol/l) among all the ethnic groups. 4. Among the participants screened, 31.9% were overweight (BMI > or = 25), 7.6% were obese (BMI > or = 30); 26.8% had raised SBP (> or = 140 mmHg) and 19.3% had raised DBP (> or = 90 mmHg); 13.6% of the participants had increased HR (> or = 90 bpm), 22% had raised TC (> or = 6.20 mmol/l) and 2% had raised GL (> or = 11.00 mmol/l). There was a higher prevalence for abnormal values with increasing age until between the ages of 60 or 70 years, when the values began to fall. 5. Age was positively correlated with SBP (r = 0.41***, df = 4351), DBP (r = 0.27***, df = 4351), TC (r = 0.22***, df = 3303) and GL (r = 0.16***, df = 2442) but negatively correlated with HR (r = -0.13***, df = 4351). The BMI was positively correlated with SBP (r = 0.29***, df = 2769), DBP (r = 0.31***, df = 2769), TC (r = 0.16***, df = 2137) and GL (r = 0.11**, df = 1637) but there was no correlation with HR (r = 0.03NS, df = 2771). The SBP and DBP were highly correlated with each other (r = 0.75***, df = 4351) and they also showed highly significant positive correlation (r = 0.08***-0.13***, df = 2441-3301) with TC and GL. TC was positively correlated with GL (r = 0.05* df = 2319) but only at the 5% probability level.

Familial hyperlipidaemia in Malaysian children.

This paper highlights two cases of paediatric familial hyperlipidaemia (hypercholesterolaemia and hypertriglyceridaemia). The first case was an 11 year old Chinese boy, a "homozygous" (Type II) hypercholesterolaemic patient. He had extremely high blood cholesterol level (19.4 mmol/l), severe multiple xanthoma and abnormal resting electrocardiogram. He had repeated heart attacks and died at the age of 15 in spite of early intervention, treatment and follow up. The second case was a 2 1/2 years old girl who had severe hypertriglyceridaemia. She had raised cholesterol (6.2 mmol/l) and extremely high triglycerides (14.8 mmol/l). The patient did not resemble Type I lipoproteinaemia which is classically seen in childhood. On the contrary, the patient exhibited clinical and biochemical manifestations of a Type V lipoproteinaemia which often occurs in adults. Apart from a Type V lipoprotein pattern, the patient had low post hepatic lipase activity (PHLA), Apo C II and Apo E2/E3 phenotype. In addition, the lipid profile of her family members (both the parents and brothers) had raised triglycerides and thus ruled out the Type I lipoprotein inheritance pattern, which is an autosomal recessive condition. The issue of paediatric hyperlipidaemia, their management and treatments are discussed.

Patients' knowledge and attitude towards treatment and control of hypertension: a nation-wide telephone survey conducted in Malaysia.

The telephone survey of 2,526 hypertensive subjects showed 94% of the respondents were aware of the importance in controlling hypertension. Among these 504 were not on anti-hypertensive medication while the majority of 2,022 were currently on anti-hypertensive medication. Of those who were not on medication, 80% (n = 403) were found non-hypertensive on follow-up. The remaining 20% (n = 101) were confirmed hypertensive and were offered medication. However, 38 subjects refused to take medication and 63 subjects complied with medication but subsequently gave up. The main reasons for giving up medication included lack of motivation (38%), doctors' advice (20%), side effects (19%) and concern of side effects (10%). Of 2,022 hypertensive respondents who were currently on medication, almost half (44%, n = 890) required a change of medication due to side effects (40%, n = 356) or the blood pressure not controlled with the previous medication (33%, n = 294). Despite the change in medication, 42% (n = 150) still continued to suffer from some form of side effects. The information obtained from this survey suggested it is important to recommend some strategies to improve patient compliance. These strategies comprise of motivating the patient, improving medication with less side effects, improving potency and efficiency of medication, and reduction of cost in medication. In addition, convenient blood pressure monitoring such as home blood pressure monitoring is also encouraged.

Serum lipids and their relationship with other coronary risk factors in healthy subjects in a city clinic.

Over a thousand subjects who visited a city private medical clinic for health screening and advice were examined for their lipid profile and other cardiovascular risk factors. The mean TC, TG, LDL-C and HDL-C were 5.43, 1.45, 3.61 and 1.15 mmol/l. Their derived ratios viz, TC:HDL-C and LDL:HDL-C were 5.11 and 3.43 respectively. The prevalence of hyperlipidaemia was moderately high. Of the subjects studied 58.5% had elevated serum cholesterol, 14.8% had raised triglycerides, 64.9% had raised LDL-C and 20.8% had low HDL-C. Male subjects generally showed higher mean values and abnormality frequency in TC, TG, LDL-C, TC:HDL-C and LDL:HDL-C as compared to female subjects. Although significant ethnic differences were not detected for certain lipid parameters (e.g. TC, TG and HDL-C), the Indians appeared to have higher mean lipid values (except HDL-C), and higher percentage abnormality for all the lipid parameters as compared to the Chinese and the Malays. In correlation studies, the following lipid parameters:- TC versus TG, LDL-C, TC:HDL-C; TG versus TC:HDL-C and LDL:HDL-C; LDL-C versus TC:HDL-C and LDL:HDL-C; were positively correlated. On the other hand, TC versus HDL-C, TG versus HDL-C, LDL-C and HDL-C, and HDL-C versus TC:HDL-C and LDL:HDL-C were negatively correlated. The coronary risk factors which generally showed positive correlations with lipid parameters were BMI and blood pressure. Positive correlations were also recorded between fasting blood glucose and TG; uric acid with TG, TC:HDL-C and LDL:HDL-C. In contrast, risk factors of negative correlations were observed between HDL-C and the coronary risk factors of BMI, diastolic blood pressure and uric acid. Smoking showed raised per cent lipid abnormality for TG, HDL-C, TC:HDL-C and LDL:HDL-C. Alcohol consumption also increased the mean level and abnormality frequency for TG. The implication of this investigation is discussed.

Health status of senior civil servants in Kuala Lumpur.

733 senior civil servants comprising 520 males and 213 females with a mean age of 44 years (range 25-56 years) were screened for their health status. The sample population comprised of 67.9% Malays, 22.5% Chinese, 9.1% Indians and 0.4% other ethnic origins. The subjects' medical histories were recorded and a full medical examination including anthropometric measurements (weight, height, waist and hip circumference), blood biochemistry and urine analysis, chest X-ray and electrocardiograms were done. The results obtained showed that 36.0% of the study population were overweight with 6.5% being obese. Of this 32.0% had central obesity. 15.2% of the subjects had systolic hypertension (systolic BP > or = 140 mmHg) whilst 27.6% had diastolic hypertension (diastolic BP > or = 90 mmHg). Hyperlipidaemia was common, with 75.2% subjects having raised cholesterol, 19.9% raised triglycerides, 50.2% raised LDL-C, 74.6% raised TC:HDL-C and 26.6% raised LDL:HDL-C. An elevated blood glucose was found in 8.4% subjects, whilst urine sugar was detected in only 2.6%, and a raised uric acid was found in 2.8% subjects. The prevalence of hypertension, raised blood glucose and hyperlipidaemia increased with age with more males affected than females. Although hypercholesterolaemia appeared more frequently amongst the Malays, the Indians, by comparison had the highest prevalence for a raised LDL:HDL-C ratio, a reflection of the increase in LDL-C and a concomitant decrease in HDL-C. The latter findings indicate that the Indians are at greater risk for the development of coronary heart disease than the Chinese and Malays. In addition, the mean levels of serum cholesterol found in this study seemed to have exceeded the levels found in populations in the industrialised countries such as the USA. There is thus an urgent need for more public health campaigns aimed at the reduction and control of such coronary risk factors.

Delayed abscess formation in the wrist due to an unusual retained foreign body--a case report.

It is well documented that retained foreign bodies can be associated with delayed abscess formation in the body. We report an unusual case of a large bomb shrapnel in the wrist of a 64-year-old Chinese woman which was retained for 52 years, causing gross wrist destruction and delayed abscess formation. An open drainage of the wrist abscess was done and the shrapnel was removed. A secondary closure was subsequently done but the patient refused another procedure for a formal wrist arthrodesis.