2009

Muttarak M, Kongmebhol P, Sukhamwang N
Correspondence: Prof Malai Muttarak, mmuttara@mail.med.cmu.ac.th

ABSTRACT
Most calcifications depicted on mammograms are benign. However, calcifications are important because they can be the first and earliest sign of malignancy. For detection and analysis of microcalcifications, high-quality images and magnification views are required. The American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) classifies calcifications on mammograms into three categories: typical benign, intermediate concern and higher probability of malignancy, according to types and distribution of calcifications. Benign calcifications are typically larger, coarser, round with smooth margins and have a scattered or diffuse distribution. Malignant calcifications are typically grouped or clustered, pleomorphic, fine and with linear branching. It is important for radiologists to detect, evaluate, classify and provide appropriate recommendations for calcifications perceived on mammograms to provide proper management.

Keywords: breast cancer, Breast imaging Reporting and Data System (BI-RADS), calcifications, mammography
Singapore Med J 2009; 50(9): 907-914

Haghdoost AA, PoorRanjbar M
Correspondence: Dr Aliakbar Haghdoost, ahaghdoost@kmu.ac.ir

ABSTRACT
Introduction The serum lipid profiles in Muslims change during the fasting month of Ramadan, but it is not clear whether this change is due to changes in their physical activities. In this study, we compared the patterns of the lipid profile changes in those who engaged in regular physical activity with those who did not.
Methods In a randomised trial, we assigned 93 students who took a physical education course into two groups – those who had regular physical activity after Ramadan and those who had physical activity during Ramadan. Venous blood (5 ml) was taken just before, at the end, and 40 days after Ramadan, and the fasting glucose sugar and lipid profile were measured.
Results Fasting with physical activity decreased body weight by 1.2 kg (p-value is 0.03). Fasting blood sugar also decreased by 7 mg/dL during Ramadan, but this drop was observed in both groups. Triglyceride decreased in both groups during Ramadan, but cholesterol levels dropped considerably during and after Ramadan for those who concurrently engaged in physical activity and fasted (-12.24 and -8.4 mg/dL, respectively). The patterns of changes in the high-density lipoprotein (HDL), low-density lipoprotein (LDL) and HDL/LDL values were more or less comparable in both groups (p is greater than 0.5).
Conclusion Usually, people are less physically active during Ramadan, but our findings show that physical activity alone cannot explain the variations in the lipid profile. Other factors, such as changes in the diet and sleeping hours, may have more important roles.

Keywords: fasting, lipid profile, physical activity, Ramadan
Singapore Med J 2009; 50(9): 897-901

Wong CS, Chu YCT, Ma KFJ, Cheng LF
Correspondence: Dr Chun Sing Wong, singsingboy@gmail.com

ABSTRACT
Introduction Spinal cord compression is a very debilitating condition and could be secondary to many causes. Urgent magnetic resonance (MR) imaging of the spine is crucial in making the diagnosis and guiding further management. Our objectives were to assess the nature of MR imaging requests, the diagnostic yield, and the subsequent management according to relevant MR imaging findings.
Methods We focused on all the urgent MR imagings of the spine conducted from July 1, 2007 to December 31, 2007. Clinical data, including the demographical information, presenting symptoms, radiological diagnosis, waiting time for MR imaging and treatment, was reviewed.
Results A total of 33 cases of urgent MR imaging of the spine were performed. Patients were aged 29–85 years, with 18 males and 15 females. Most of them (84.8 percent) presented with neurological symptoms. 84 percent of the MR imaging was performed within 24 hours. 76 percent of the examinations yielded significant cord compression, of which 56 percent were due to vertebral metastasis, while others were due to epidural haematoma (12 percent), infective spondylodiscitis (8 percent), vertebral fracture (8 percent) and disc herniation (16 percent). Of the vertebral metastasis patients, 43 percent had one region imaged. 64 percent of the cord compression patients received surgical treatment or radiotherapy, with a mean waiting time of 1.7 days.
Conclusion The urgent MR imaging spine service was able to react promptly with a high diagnostic yield. One-third of the patients with vertebral metastasis had multiple levels involved, and imaging of the whole spine would be useful.

Keywords: radiotherapy, spinal cord compression, spine imaging, vertebral compression fracture, vertebral metastasis
Singapore Med J 2009; 50(9): 894-896

Baltas CS, Balanika AP, Sgantzos MN, Papakonstantinou O, Spyridopoulos T, Bizimi V, Tsouroulas M, Guglielmi G
Correspondence: Prof Giuseppe Guglielmi, g.guglielmi@unifg.it

ABSTRACT
Introduction We used ultrasonography to detect the presence of biliary sludge or gallstones in Greek patients with complete high spinal cord injury (SCI) above the seventh thoracic segment (T7), within the first six months from injury onset, in order to evaluate the effects of neurological instability and dysfunction of the sympathetic nervous system (SNS) on the gallbladder function in the early post-SCI phase.
Methods We evaluated 78 asymptomatic patients (57 males, 21 females; mean age 34.8 (range 19–56) years) with complete high SCI located above the T7 segment, and 78 healthy subjects (59 males, 19 females; mean age 35.2 (range 21–59) years) matched for age, gender and race, for a total period of 39 months. All the participants underwent ultrasonographical examination of the gallbladder and common bile duct within the first six months from the injury, in order to investigate the development of biliary sludge and gallstones.
Results The incidence of biliary sludge was significantly higher in patients with SCI compared with the control group. The incidence of biliary sludge and gallstones was also significantly higher in patients with SCI patients in comparison with the healthy subjects. In male SCI patients, the incidence of biliary sludge was significantly increased in comparison with healthy subjects. No significant difference was revealed between the two groups in detection of gallstones.
Conclusion Our study indicates that the detection of gallbladder sludge and gallstones are significantly higher in Greek patients with complete high SCI above the T7 segment, as compared with healthy control subjects within the first six months of the injury onset. The complete disruption of the SNS and the neurological instability in the early post-SCI phase is probably responsible for the biliary sludge and gallstone formation. Our results suggest that ultrasonography should be performed in these patients at the first 3–6 months from the injury for the early diagnosis of the lithogenic bile.

Keywords: biliary sludge, gallstones, spinal cord injury, ultrasonography
Singapore Med J 2009; 50(9): 889-893