At Normah Medical Specialist Centre, human resource is our greatest asset. We provide a friendly and caring environment that promotes team spirit, respect for the dignity and merits of its employees and upholds just and ethical management practices. We provide Quality Health Care to our patients through highly competent and professional personnel using the very latest medical science and technology. Come join our team and share our vision and mission to be the best Healthcare Provider

Qualified candidates are invited to apply online or write-in with full personal details, educational and employment history, contact telephone numbers, e-mail address, certified (notarised) copies of certificates/degrees and 2 recent passport-sized photographs (non-returnable) to:

Our postal address:

The Human Resources Manager
Human Resources Department
Normah Medical Specialists Centre
Lot 937, Section 30 KTLD
P.O. Box 3298,
93764 Kuching,
Sarawak, Malaysia

There is evidence that radiation combined with chemotherapy can increase median survival time in patients with locally advanced tumors. In addition, neoadjuvant concurrent chemotherapy and radiation therapy (CCRT) may be effective in treating borderline resectable cases of pancreatic cancer, explained Dr. Mi-Suk Park and colleagues from Yonsei University College of Medicine in Seoul in Radiology (January 2009, Vol. 250:1, pp. 110-117).

However, inasmuch as toxicity and disease progression are major obstacles during neoadjuvant CCRT, it would be useful to predict which tumors will respond to treatment and which will not, Park and colleagues wrote. The optimal treatment would be intensive enough to maximize the chance of tumor regression while avoiding unnecessary toxicity.

“Perfusion computed tomography is a clinical technique that can be used to provide regional maps and obtain quantitative measurements of various hemodynamic parameters on the basis of the linear relationship between CT enhancement and iodinated contrast material concentration,” and the development of MDCT and perfusion software has facilitated this task, wrote the authors.

The study aimed to “prospectively determine whether perfusion CT parameters, such as the volume transfer constant (K^trans) between blood plasma and extracellular extravascular space (EES) and the blood volume calculated from dynamic CT data, can be used to predict the response of pancreatic cancer to CCRT,” they wrote.

The researchers recruited 63 patients who were scheduled to undergo pretreatment staging of suspected pancreatic cancer. All had adequate renal function (serum creatinine level ? 2.0 mg/dL), but 33 patients were excluded for reasons including chemotherapy without radiation (n = 10), surgery without neoadjuvant CCRT (n = 2), cancer other than pancreatic adenocarcinoma at tissue biopsy (n = 11), nondiagnostic CT, a lack of follow-up imaging (n = 5), or tumor less than 1 cm in diameter (n = 5).

The remaining 30 patients with biopsy-proven adenocarcinoma underwent perfusion CT with 64-detector-row CT before CCRT. The treatment included daily external-beam radiation therapy at a planned total dose of 4,500 cGy for 23 patients with tumors in the head of the pancreas and 5,040 cGy for those with cancer in the body and tail of the pancreas (n = 7), administered at 180 cGy along with gemcitabine-based chemotherapy (Gemzar, Eli Lilly, Indianapolis).

Perfusion CT was performed on a Sensation 64 scanner (Siemens Healthcare, Erlangen, Germany). The tumor was localized at noncontrast CT, followed by a dynamic exam of the target region performed at end expiration. Iodinated contrast (50 mL iopamidol, Bracco, Milan, Italy) followed by 50 mL saline was injected at 4 mL/sec via a power injector (EnVision CT, Medrad, Warrendale, PA).

Four contiguous 7.2-mm thick sections were acquired at one-second intervals through the midpoint of the tumor by using a cine-mode acquisition (100 kVp, 100 mAs, 4-mSv effective dose). CT scanning was initiated five seconds after the start of injection.

Two minutes later, following injection of less than 150 mL of nonionic iodinated contrast, pancreatic and portal-phase dynamic CT were performed at 40 and 60 seconds, respectively, after contrast media injection. Parameters included 120 kV, 200 to 250 mAs effective dose, 64 x 0.6-mm collimation, 3-mm image thickness, and 3-mm increment reconstruction.

For follow-up CT at three and six months, two-phase dynamic CT scanning was performed without perfusion CT to evaluate treatment response. The researchers compared two perfusion parameters (K^trans and blood volume) measured before treatment, comparing responders to nonresponders according to World Health Organization criteria.

Of the 30 patients, 20 (mean age, 66.6 years; age range, 55-79) examined at three months responded to therapy, with bidimensional tumor size reductions of at least 50%. Ten patients (mean age, 65.8 years; age range, 53-77) who did not meet this criterion were deemed nonresponders.

Responders’ pretreatment K^trans values were significantly higher than those of nonresponders (50.8 mL/100 mL/min ± 30.5 standard deviation versus 19.0 mL/100 mL/min ± 10.8, p = 0.001). “The best cutoff value for differentiating between responders and nonresponders was 31.8 mL/100 mL/min, which yielded 75.0% sensitivity and 90.0% specificity,” the group reported.

Ten of 18 patients examined at six-month follow-up had responded to therapy. Similar to the three-month follow-up, their pretreatment K^trans values were significantly higher than those of nonresponders (58.6 mL/100 mL/min ± 43.2 versus 19.8 mL/100 mL/min ± 10.9, p = 0.02). Responders also had insignificantly higher blood volume values.

The baseline higher K^trans values seen in responders “could indicate better delivery of the chemotherapeutic drug to the tumor,” the authors wrote. “Gemcitabine, which was the main chemotherapeutic drug used in our study, is a cytotoxic agent that targets DNA and RNA and acts as a radiosensitizing agent. Thus, increased delivery of gemcitabine may induce an increased radiosensitizing effect and an increased cytotoxic effect, resulting in good response to CCRT.”

Images obtained in a 63-year-old man with locally advanced pancreatic head cancer who was a member of the responder group. Above, transverse contrast-enhanced baseline CT image shows a locally advanced pancreatic head cancer mass. The long-axis diameter of the mass was 48.0 mm, and the perpendicular diameter was 22.2 mm. The bidimensional product was 1,016 mm2. At that time, the CA 19-9 level was 3,130 U/mL.

CT image obtained three months later at first follow-up shows partial response of the pancreatic head cancer mass, which decreased in size to 388 mm2. The CA 19-9 level was 409 U/mL.

Baseline perfusion map reveals a Ktrans value of 53.8 mL/100 mL/min, which is higher than the best cutoff value (31.8 mL/100 mL/min). The scale does not include the peripheral portion of the tumor (red). This case shows three zones, two of which have high perfusion (left small and right large areas) and one that has low perfusion (central area). Presumably, this reflects the fact that pancreatic cancer may have heterogeneous perfusion even though it appears to be a homogeneously enhancing mass on conventional contrast-enhanced CT images.

Baseline blood-volume perfusion map shows a volume of 4.4 mL/100 mL, which is higher than the best cutoff value (2.8 mL/100 mL). All images republished with permission of the Radiological Society of North America from: Park MS, Klotz E, Kim MJ, et al. Perfusion CT: Noninvasive surrogate marker for stratification of pancreatic cancer response to concurrent chemo- and radiation therapy. Radiology. 2009;250(1):110-117.

Only a few studies have sought to evaluate the value of perfusion CT as a therapeutic monitoring method in patients with tumors. Among them, Sahani and colleagues found that rectal cancer patients with initial high blood flows and shorter mean transit times showed a poor response to CCRT, the authors noted.

Another study, by Zima and colleagues, examined patients with upper aerodigestive squamous carcinomas with perfusion CT. Initial high blood flow, high blood volume, and high capillary permeability were correlated with a good response to chemotherapy. The results suggested that higher perfusion values may correlate with better oxygen and drug delivery.

Limitations of the study included radiation exposure in the range of 4 mSv, and a smaller sample size than anticipated because several studies had to be discarded for poor image quality. The authors also noted the complexity of scanning patients with abdominal tumors, imperfect breath-holding, and artifacts from intra-abdominal air, which limit the quality of the voxel time-attenuation curves that are entered into the mathematical models of the evaluation software.

“The small enhancement of pancreatic carcinoma further reduces the signal-to-noise ratio,” they wrote. The Patlak method used in the study is fairly robust and needs few data points, which enabled scanning time to be reduced to 30 seconds.

“Pancreatic tumors with high pretreatment K^trans values indicating higher intratumoral flow tended to respond better to the gemcitabine-based CCRT,” the researchers concluded. Pending the completion of larger studies, “perfusion CT may be used to predict the tumor response of CCRT in patients with pancreatic cancer and to aid in the development of tailored therapy.”

By Eric Barnes
AuntMinnie.com staff writer
January 2, 2009

Then a guide wire is carefully passed through the needle and gently pushed into the artery and upwards towards your chest.
Malpractice Medical
Once the wire’s in place at the aorta, a narrow tube, called a catheter, is threaded along the wire until it too has reached the aorta.

The guide wire will then be withdrawn, leaving the catheter in place.
Next, the doctor injects a dye - specially designed to show up under x-rays. The dye will outline the blood vessels that feed that heart and will allow your doctor to pinpoint areas where blood flow has been reduced.
Malpractice Medical
After a thorough investigation, the catheter is withdrawn… and slight pressure is applied to the incision in your leg in order to prevent bleeding. The dye that was injected will break up and leave your body as waste.

The heart is located in the center of the chest. It’s job is to keep blood continually circulating throughout the body.

The blood vessels that carry oxygen-rich blood away from the heart are called arteries.
Medical Malpractice
The largest and most important of these is the aorta.

The vessels that bring blood back into the heart are called veins.

Sometimes, these blood vessels can grow narrower or become blocked in such a way that normal blood flow is restricted. In simple terms, a cardiac catheterization is a diagnostic procedure used when your doctor believes that blood is not flowing normally in and or around your heart.

Medical Malpractice
In simple terms, a cardiac catheterization is a diagnostic procedure used when your doctor believes that blood is not flowing normally in and or around your heart.

During a cardiac catheterization, a heart specialist will insert a thin tube into an artery in the arm or leg and gently guide it towards the problem area in the heart.
Medical Malpractice
Once the tube is in place, a special dye is injected and a series of x-rays are taken.

These x-rays allow your doctor to see exactly how blood is flowing in your heart.

Dr. Cecilia Mercado and colleagues reviewed the results of 135 ultrasound-guided needle localizations during a 21-month period for a study published in the American Journal of Roentgenology (October 2008, Vol. 191:4, pp. 1216-1219).

Because some breast malignancies are visualized with sonography but not mammography, the authors used sonography for preoperative marker placement to assess whether this might improve the accuracy of lesion excision and adequate inclusion of lesion margins.

The researchers retrospectively evaluated lesion type and size and appropriate wire and marker placement. Using mammography, they evaluated the distance between the localizing wire and lesion marker. Also, specimen radiographs were assessed for wire and localizing markers within the lesion.

A 21-gauge modified Kopans spring-hook localization needle was placed into and through the lesion under ultrasound guidance. A hookwire was inserted through the needle and the needle was removed. A 14-gauge introducer was used to place the breast marker, which was a localizing clip embedded in a bioresorbable collagen plug (Cormark, Ethicon Endo-Surgery, Cincinnati).

The researchers divided 121 patients into two groups, but only one group had markers placed in the lesion following needle localization. For the group with markers placed, the authors confirmed lesion or marker excision using specimen radiography (at surgery) in 97% of lesions. However, for the group without markers placed, they confirmed lesion excision using specimen radiography in 23% of lesions.

Results showed that “of the 11 malignant lesions (19%) localized with marker placement, none had a positive inked margin, but five (46%) had close margins necessitating re-excision. Of the 26 malignant lesions (34%) localized without marker placement, two (8%) had a positive inked margin, and eight (31%) had close margins necessitating re-excision,” they wrote.

The authors concluded that placement of a marker “aids in identifying mammographically occult lesions within specimens and enables immediate confirmation of accurate surgical removal of localized lesions at surgical excision.” Although the study demonstrated an increase in the number of lesions with clear inked margins, there was no significant difference in the number of lesions needing re-excision.

“Sonographically Guided Marker Placement for Confirmation of Removal of Mammographically Occult Lesions After Localization”
C. Mercado et al
Department of Radiology, New York University School of Medicine, New York University Cancer Institute, 160 E. 34th St., 3rd Floor, New York, NY 10016
AJR 2008; 191:1216-1219

By Radiology Review
December 30, 2008

Copyright © 2008 AuntMinnie.com

“In the evaluation of postoperative complication after prostatectomy, MDCT cystography may be a useful modality for cases of clinically suspected vesicourethral leakage that show negative findings in conventional cystography,” Dr. Sung Il Hwang from Seoul National University College of Medicine, Republic of Korea, told Reuters Health.

Dr. Hwang and colleagues compared the detection rates of MDCT cystography and conventional cystography in the evaluation of vesicourethral leaks after radical prostatectomy in 46 patients.

MDCT cystography detected 37 of 46 leaks (80.4%), the authors report, whereas conventional cystography detected 25 of the 46 leaks (54.3%).

The mean volume of leakage detected only by MDCT cystography (2.2 mL) was lower than that seen on both MDCT and conventional cystography (19.3 mL), the report indicates.

“We think that accurate diagnosis and proper management of the leakage detected by MDCT may reduce hospital stay and prevent postoperative urinary incontinence of patients who undergo prostatectomy,” Dr. Hwang concluded.

“CT has some drawbacks for routine examination, because of its cost and radiation,” Dr. Hwang commented. “We recommend MDCT only in cases with higher risk of leakage, for example, cases with technical difficulties during the anastomosis procedure or cases with short length of membranous urethra shown in preoperative MRI. In addition, MDCT cystography is helpful in patients with sustained drainage from the drain tube, which may suggest continuous leakage from the anastomotic site.”

By Will Boggs, M.D.

We have Your Best Interest At Heart

One of our mission statements is to be the best employer that continuously builds our people to develop the organization and vocation. We have created conducive environment for our employees to expand their capabilities and talent as well as provide them with sufficient tools towards realizing their full potential in their respective areas of specialization.

We establish bench mark programs to inspire our workforce. We continuously support, guide and provide your exposure locally and through our affiliations with foreign healthcare providers. As the only tertiary heart centre in Malaysia, Institut Jantung Negara’s vision aspire to be the Global Center Of Excellence For Cardiovascular and Thoracic Care.

We firmly believe that teamwork shapes our human capital. We ensure that we find the right people for the right role.

Responsibilities:

Perform non-invasive/invasive Lab procedures

Requirements:

* Bachelor’s Degree in Imaging Diagnostic and Radiotherapy/Diploma in Radiography/Medical Imaging
* Candidates with the experience and knowledge in radiography related equipment will be given priority
* Excellent interpersonal , communication and analytical skills
* The selected candidate will be required to undergo minimum 1 year training

Benefits:

* Attractive Remuneration packages
* Tiered EPF employer contribution between 12% to 15%
* Cost of living allowance (COLA)-Where applicable
* Holiday reimbursement
* Hospitalization & Surgical coverage
* Group term life insurance
* Learning & growth opportunities
* Housing & Vehicle loan arrangement

All applications will be treated strictly confidential. Please indicate the position applied for at the top left-hand corner of the envelope

Only short-listed candidates will be notifed. Closing date: 3 january 2009

Recruitment Section
Human Capital & Organisational
Development Division
Institut Jantung Negara SDN BHD (245794-V)
145, Jalan Tun Razak,
50400 Kuala Lumpur
Malaysia

Email: hrd@ijn.com.my
Webpage: www.ijn.com.my

A private tertiary hospital with 232 beds located strategically in the heart of Klang Town with easy accessibility. In line with our on-going effort to further enhance our services, we therefore invite self-motivated, dedicated tem players and result orientated individuals to join us as:

RADIOGRAPHER

* Minimum 2 years experience
* Diploma or degree in Radiography
* Female preferred
* Fresh graduates are encouraged to apply

Interested candidates are required to send in their detailed resume stating experience, current and expected salary to the address below before 9th January 2009:

The Human Resources Department
SRI KOTA SPECIALIST MEDICAL CENTRE
(Managed By Southern Medicare SDN BHD)
Jalan Mohet, 41000 Klang,
Selangor Darul Ehsan
Tel: 03-33733636 ext. 7307/7327
Fax: 03-33736888
Email: Michael@srikotamedical.com
Website: www.srikotamedical.com