i-exposure

Island Hospital Sdn Bhd (Co. No.: 323705 A)

Volume 15 / 2014

www.islandhospital.com

OPY
C
E
FRE
i Caf 2
PACS

3D Laparoscopy
System

Occupational
Therapy

i-Sports

Teach Your Child

to Listen

Siemens
Magnetom Spectra
3T MRI

Looking at the
Coronary Artery
from Inside-out
Angioplasty Using
ABSORB Vascular
Scaffold
Revealing Your
New Confidence
and Beyond with
Plastic Surgery
BD SurePath
- New Liquid
Based Cytology
Pap Smear Test

10

Getting to Know our

New Consultants

17

12
14
16

Indonesian Section:
Ancaman
Dari Obesitas

17

Amankah Operasi
Plastik?
In-house Antenatal
Classes 2014

20

We are ISO certified

Certificate No: KLR 0500345

A New Phase Towards

Patient Care
New Deluxe Rooms

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Vol 15

2
Food Buffet

Counter

i Caf

Year 2013 has brought some major changes to the

Dietetic and Food Service Unit. In order to be in line
with Island Hospitals expansion, a few new facilities
and service advancement has been planned and
carried out to enhance and provide the best service
to our valued customers and staff.

i Caf New Island Hospital

Cafeteria

As part of Island Hospitals commitment

to comfort always, a brand new
cafeteria has been planned as part of the
new hospital expansion. The new cafeteria
aims to provide comfortable and enjoyable
eating experience to all our valued
customers and staff. The anticipitated
opening was officially launched on the
19th August 2013 and was named
i Caf. The new facility offers an area
space of 175 square meters with sitting
capacity of about 130 seats. The cafeteria
is located next to the new Emergency Unit
(A & E) with 2 entry / exit doors. There
are other facilities available like television
viewing, clinic call number system and
WiFi. The cafeteria is open for service
from Monday to Saturday (closed on
Sundays and public holidays) from 8.00am
to 6.00pm (Monday to Friday) and from
8.00am to 2.00pm (Saturday).
Choices of menu available are:
1. Light snacks and finger food
(cakes, buns, traditional desserts,
pastries, sandwiches and a wide range
of savory items)
2. Fried noodles, soupy noodles and
hawkers food delights
3. Rice with a wide choice of dishes
from Malay, Chinese, Indian, Nyonya
and vegetarian cuisine
4. Weekly promotion items (local,
other Malaysian specialties and
international cuisine)
5. Steamed and low fat choices (buns,
pau with a variety of fillings, tim sum,
special soups and steamed dishes)
6. A wide range of beverages
(hot and cold) as well as fresh juices
and freshly cooked traditional drinks

i-Caf

Sitting

Area

i-Caf Sittin

g Area

7. An interesting selection of fruits,

cold dessert and hot dessert
8. Ala-carte orders
The food service provided in the cafeteria
and inpatients meals has been certified
HALAL by JAKIM since 2009.

Computerised Inpatient Meal

Ordering System
The Dietetic and Food Service Unit is
commencing an online meal ordering
system for inpatients with the expertise
provided from the IT Department. The
system aims to provide fast, effective and
accurate meal ordering for the patients of
Island Hospital. The system will capture
orders from a range of 6 types of menus
inclusive of therapeutic diets ordered
for the inpatient wards. The system will
minimise meal time ordering, tabulate
data for the kitchen staff as well as
provide data for analysis and continuous
improvement in the Food Service.

The new meal serving system will ensure

better temperature control and hotter
meals for the inpatients. The system uses
convection heating technology, improves
performance, reliability and enhance the
food products. The system will enable
meals to be kept warm for longer period
of time without compromising the food
value and presentation. Temperature can
be maintained at 80-90 degrees Celsius for
at least 45 to 60 minutes. The system will
commence at 8th floor VIP wards and will
be gradually extended to the other floors
in stages.

One-stop Food Service Centre

The Island Hospital Food service has
now being consolidated into a one-stop
area with additional facilities to support
the growth of the hospital. Additional
4 storage rooms, bigger cold kitchen and
new upgraded equipments like walk-in
chiller room and 2 walk-in freezer rooms
will ensure services provided are at the
best control in terms of quality, variety,
freshness and food safety.

Socomel Meal Serving System

The Dietetic and Food Service Unit is
embarking into a state-of-the-art meal
delivery system developed by Socomel.
The trays are loaded in the kitchen and
rethermalization without handling.

The Dietetic and Food Service Unit will

continue to find solutions and creative
ideas to further delight and meet our
valued customers and staff needs. We
value constructive feedback and priceless
suggestions to help us continue to serve
you well. Please provide your kind opinion
and suggestion through our Food Service
Questionnaire available in the cafeteria
and ward levels.

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PACS

Vol 15

Picture Archiving and

Communication System
Island Hospital have recently updated the computerisation of medical
imaging communication within the hospital using the Picture Archiving
and Communication System (PACS). The PACS is a medical imaging
technology which provides economical storage of, and convenient access
to, images from multiple modalities (source machine types), allowing
digital transmission of electronic images and reports, eliminating the need
to manually file, retrieve or transport film jackets. Using this system, images
are stored and transfered as DICOM (Digital Imaging and Communication
in Medicine) format. Non-image data such as scanned documents can be
incorporated using PDF file format once it is encapsulated in DICOM.
A PACS consists of four major components:
Imaging modalities such as general x-ray, computed tomography (CT),
magnetic resonance imaging (MRI), ultrasound, mammogram, etc.
HIS and RIS secured network for transmission of patient information
Workstations for interpreting and reviewing images
Archives for information storage and retrieval
3 Tesla MRI

Computerised Direct Digital X-Ray

Advantages of PACS
Most PACS can handle images from various medical imaging instruments,
including ultrasound (US), magnetic resonance (MR), positron emission
tomography (PET), computed tomography (CT), endoscopy (EX),
mammogram (MG), digital radiography (DR), computed radiography (CR)
and many more. Combined with web technology, PACS breaks down the
physical and time barrier associated with traditional film-based image
storage, retrieval, distribution and display, further allowing timely and
efficient access to images, interpretations and related data.
In view of its advantages in facilitating the storage and distribution of
medical records and communication, various clinical areas beyond
radiology, cardiology, oncology, gastroenterology and even the laboratory
are creating medical images that can be incorporated in PACS.
As such, Medical Imaging is now operating filmless and towards paperless.

i-exposure

Vol 15

3D laparoscopy
system leading to a quantum

by Datuk
Dr Liong Men Long, DMSM
Consultant Urologist
MBBS (Mal.), FRCS (Edin.),
FRCS (Glasg.)

leap in management of complex and

challenging urological procedures

These technological advancements

provide surgeons with improved
speed, accuracy and greater
precision for difficult surgical tasks.

technically difficult cases still require the

good old open surgery or the efficient but
expensive robot-assisted system.
However, the new Olympus 3D
laparoscopy becomes a good substitute
for the robot-assisted system. It provides
a more accurate depth perception and
precise spatial view of the internal organs
that cannot be achieved with 2D system.

In urology since 1990, laparoscopy has

been widely used to manage cancer cases
and reconstructive procedures. Ablative
procedures involving removal of diseased
organs using 2D laparoscopy system
gradually replaced open surgery. However,

Unique innovations include:1) A deflectable tip that can be bent

up to 100 degrees in four directions,
providing not only clear vision on
a frontal view of the tissue operated on,
but also from other angles including
from behind, improving view during
technically difficult procedures
2) The autofocus also eliminates the
problems of manual focusing for
surgeon and assistants
3) The high resolution CCD image sensors
allow observation of tissues with finest
details

4) The dual lens 3D optical structure

creates a correct and greater depth
of surgical field providing a very precise
and realistic view of the tissues and
organs operated on
These technological advancements provide
surgeons with improved speed, accuracy
and greater precision for difficult surgical
tasks. Urological procedures usually
involve dissections in close proximity to
major vessels and necessitate isolation of
delicate nerves during prostatic cancer
surgery to preserve erectile function.
Reconstructive procedures also entail fine
and precise intra-operative suturing within
close confined spaces. These advantages
will shorten surgeons learning curve
and increase confidence and opening up
possibilities for taking on more challenging
cases.
Since June 2013 till April 2014, in a short
span of 11 months with the Olympus 3D
laparoscopy system, the dedicated urology
team has performed various challenging
cases as summarised in the table below.

Total laparoscopic uro-surgical cases using 3D camera system (June 2013 - April 2014)
ORGAN
Kidney

PROCEDURE

DIAGNOSIS
A) Renal masses

I) Carcinoma

MAXIMUM SIZE
Cryosurgery
Partial Nephrectomy

Radical Nephrectomy
II) Non cancerous cases
(Angiomyolipoma)
B) Nonfunctioning Kidney
(with/without stone)
C) Duplex System
Ureter and Pelvis
Calyceal System

A) TCC of Renal Pelvic and Ureteric

B) PUJ Stricture

Bladder

Bladder Carcinoma

Prostate

Prostate Carcinoma

TOTAL

Partial Nephrectomy

4cm
4cm
4.1 - 7cm
7.1cm
4cm
4.1 - 7cm
7.1cm
4cm
4.1 - 7cm
7.1cm

1
5
6
1
1
3
5
1
1

TOTAL
1
12

Nephrectomy

Partial Nephrectomy plus Ureterectomy

Radical Nephroureterectomy plus Bladder
Cuff Excision
Dismembered Pyeloplasty
Radical Cystectomy Ileal Bladder
Radical Cystectomy Ileal Conduit
Radical Prostatectomy and Bilateral Pelvic Lymph
Node Clearance

1
3
3
1
3
11
49
cont. page 5

5 i-exposure

cont. from page 4

A) 3D laparoscopy for
renal masses requiring
nephron-sparing surgery

E) Bladder cancer surgery

Radical cystectomy entails removal of
bladder, prostate in male and uterus
and upper third vagina in female plus
the surrounding regional lymph nodes
for cancer cure. Second step involves
urinary diversion to allow urine drainage
using ileal conduit or ileal bladder (i.e.
artificial bladder reconstructed from small
intestine).

With easy availability of ultrasound,

detection of early solid renal masses
(cancer and non cancer cases) has
increased in frequency and is now
a common clinical scenario for doctors.
Renal cell cancer accounts for 2% of
all adult cancer but is the most lethal
urological cancer. Approximately 35% of
kidney cancer patients die from the disease
at the 5-year mark. Complete surgical
resection remains the gold standard
treatment. Since 1990, laparoscopic
complete removal of cancerous kidney has
gradually replaced open surgery.
For early stage (T1) renal cancer (i.e. tumor
confined to kidney and 7cm in
greatest dimension), removal of tumor
with 2mm- 5mm surgical margin
(nephro-sparing) kidney preservation
surgery in contrast to complete removal
offers similar cancer free survival rate.
Published clinical data confirmed nephronsparing surgery has significantly lower rate
of cardiac event and reduced chance of
chronic kidney disease.
However, nephron-sparing surgery
(i.e. partial nephrectomy) is still greatly
underused even in the USA. The main
challenges are vascularity of kidney and
surgeon has a very limited time clamping
the renal artery, completely excise the
tumor, suture the significant bleeding
vessels and reconstructing the kidney
collecting system in 30 minutes,
i.e. the critical warm ischaemic time.
Clamping more than 30 minutes results
in permanent damage to the preserved
kidney. This demanding step deters many
urologists from laparoscopic nephron
sparing surgery.
Personally after over 10 years of
laparoscopy experience, I find 3D
laparoscope is the closest surgeons can
utilize like the robot-assisted system.
Nephron-sparing procedures can be
performed with confidence using
retroperitoneal approach rather than
transperitoneal (i.e. going in front via
the intestine filled peritoneal cavity).
For patients, the benefits include excellent
cancer control, precise tumour removal
and kidney reconstruction, less blood loss,
lower rate operative complications,
shorter hospital stay (average 2-3 days)
and speedy convalescence.
For surgeons, the biggest advantage is
easy and precise intracorporeal suturing
for significant vessels and calyceal
reconstruction keeping warm ischaemic
time 30 minutes.

Vol 15

B) 3D laparoscopy for
nephrectomy,
nephroureterectomy
(cancer of the urinary
drainage system from pelvis
to ureter and bladder)
Advantages in addition to those
mentioned above, include:
Efficient identification of target
anatomy, anatomical boundaries
Accurate vessel dissection, ligation and
urethral transection
Bladder cuff excision and repair that
usually require Pfannenstiel incision
can be performed completely by
laparoscopy only

C) Ureteric, pelvic and

bladder reconstructive
procedure
Undoubtedly, fine dissection and suturing
involving ureteric diameter of 5mm will
be enhanced with the 3D system features
of Olympus.

D) Prostate cancer surgery

Open radical prostatectomy procedures
have been gradually replaced by robotassisted state-of-the-art minimally
invasive procedure. 3D laparoscopic offers
features close enough to robot-assisted
system enhancing laparoscopic radical
prostatectomy.

The surgery takes a tedious 6 - 10 hours

to complete and have complication rate
up to 30 - 40%. 3D laparoscopy will
not require big abdominal incision and
exposure of the intestine contents to the
atmosphere for hours.
For patients, the benefits include:
Fewer major complications
Less blood loss, transfusion
Less pain
Improved cosmesis
Shorter hospital stay and faster
recovery time
For surgeons, the benefits include:
Better operative and oncologic
outcomes
Meticulous dissection of bladder and
lymph nodes
For ileal bladder, a better and
watertight anastomosis between
neobladder and urethra
Less massive blood loss during surgery
A more rapid return of bowel function
for patients
In conclusion, Olympus 3D laparoscopy
allows surgeons to perform various
advanced laparoscopy cases very close to
the advantages offered by the expensive
robot-assisted system, but at a much more
affordable price.
It is an affordable good substitute for
surgeons wanting to perform advanced
challenging cases that are normally
performed with the expensive robotassisted system. It is a dream come true
for highly motivated doctors.

The clear vision enhances neuromuscular

bundle preservation for patients wishing
to preserve erectile function. Precise
intracorporeal suturing and reconstruction
of the urethra and the bladder neck and
preservation of sphincter muscle allows
early return of urinary continence.
For patients, the advantages include less
pain, less infection, less scarring, less
blood loss and transfusion and quicker
convalescence.
E

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Vol 15

Occupational Therapy
Occupational therapy incorporates your valued
occupations into the rehabilitation process.

WHAT is Occupational
Therapy?
Your lifes occupations meaningful
and purposeful everyday activities.
Your roles in life:
A parent, a friend, a tennis player, an
artist, a cook, a housewife, or a musician.
Everyone has occupations:
1. Toddlers occupations: play and learn
to develop important skills.
2. Adults occupations: engaging with
family and friends and managing his or
her home.
We generally dont think about our
daily occupations until we have trouble
doing them.
Occupational therapy incorporates
your valued occupations into the
rehabilitation process.

WHO are Occupational

Therapy Practitioners?
Occupational therapy practitioners are:
1. Skilled healthcare professionals who
use research and scientific findings
to help clients of all ages improve their
ability to participate in activities
at home, work, or leisure.
2. Practitioners with strong knowledge
of a persons psychological, physical,
emotional, and social make-up.
3. Practitioners who help to evaluate
how your condition (or risk for one)
is affecting your body and mind using
a holistic perspective.

WHY would I need

Occupational Therapy?
Occupational therapy allows people of
all ages to do the activities they want
and need to do.
An occupational therapist will:
1. Evaluate your situation
2. Develop individualized goals
3. Work together on a specific
intervention plan
4. Get you back to your life

WHEN do I need
Occupational Therapy?

by Mr Khor Wai On
Bachelor of Occupational
Therapy (Hon) (UKM),
Occupational Therapist (MOTA)

TREATMENTS Provided:

An occupational therapy practitioner

helps you to keep the focus on the
things you need and want to do
your goals, your activities, being
independent.
With occupational therapy services you can:
1. Achieve goals - help your teenager
with a developmental disability to gain
the skills to transition from high school
to independent living as an adult.
2. Stay as healthy and productive as
possible, while managing a chronic
medical condition e.g. Arthritis and
Dementia.
3. Maintain or rebuild your independence
- using assistive devices so you can care
for yourself after a stroke.
4. Participate in the everyday activities
important to you - driving, visiting
friends, performing prayers, and other
activities that keep you involved with
your community.
In short, an occupational therapy
practitioner can help you live life to the
fullest no matter your health condition,
disability, or risk factors.

HOW do I schedule an
Occupational Therapy visit?
Get a referral from your physician for
occupational therapy services to i-Sports
Rehabilitation Center itself.

Common CONDITIONS
Treated:

1. Activity of Daily Living Training

2. Hand Function Training
(Daily tools / Rejoyce hand simulation)
3. Cognitive & Perceptual Training
4. Functional Academic Training
5. Splinting
6. Sensory Stimulation
7. Relaxation Therapy
8. Early Intervention Program
9. Sensory Integration Therapy
10. Behavioral Intervention Program
11. Home Program
12. Aids & Adaptations Recommendations

WHERE Can I get

Occupational Therapy?

Physical:
Stroke, Spinal Cord Injuries, Myopathy,
Amputation, Head injuries, Tendon Cut,
Fracture, Diabetes Mellitus, Rheumatoid
Arthritis, Osteoarthritis, Dementia,
Alzheimer Disease, Parkinson and etc.
Pediatric:
Autism, Attention Deficit Hyperactive
Disorder (ADHD), Attention Deficit
Disorder (ADD), Learning Disability,
Down Syndrome, Developmental Delay,
Cerebral Palsy and etc.

Island Hospital
i-Sport Rehabilitation Centre
308, Macalister Road, 10450 Penang, Malaysia.
Tel: 04-238 3214 / 220 5530
Email: isports_rehab@yahoo.com
E

7 i-exposure

i-Sports

Physiotherapy & Rehabilitation Centre

Deft Gravity
The AlterG Anti-Gravity Treadmill
provides precise early walking
following injury or surgery to restore
a natural walking motion. It enables
muscles to work with balance and
confidence, and improves normal
walking motion post injury. The
AlterG also provides conditioning &
re-training with significantly REDUCED
PAIN. The machine works by lifting
your body weight up to 80% so that it
is easier to walk or run without pain.
It also benefits patients who have
hip, knee or ankle problems as well as
certain types of strokes.
This machine is also used for
high level athletic training and
rehabilitation for the Olympic &
National teams. Patients who have
tried it have improved tremendously
over a short period of time &
increased their walking & running
ability.

Hand, Arm and Shoulder

Rehabilitation
Rejoyce is an upper limb (hand &
arm) rehabilitation workstation that
is used in clinics around the world.
It features a range of exercise games
with adjustable levels of difficulty and
a standardized hand and arm function
test. Rejoyce is designed for both
rehabilitation of normal daily tasks
& exercises. These improvements in
function are easy to visualize using
graphs to motivate the patient.

Vol 15

Tel: 04-238 3214 / 220 5530

The AlterG Anti-Gravity

Treadmill M300

The Anti-Gravity Treadmill works best for

patients who need:
Rehabilitation following injury or surgery of the
lower extremity (hip, knee, ankle or foot)
Rehabilitation after total joint replacement
Gait training in neurological patients
Strengthening and conditioning in older patients
Weight control and reduction
Sport specific conditioning programs
Aerobic conditioning

Athletes Train Like Never Before

The worlds best athletes and sports teams consider
the Anti-Gravity Treadmill an essential part of their
athletic conditioning and rehabilitation programs:
Strengthens and improves coordination of muscles,
which in turn protects surrounding joints
Promotes the full range of motion while
minimizing stress
Enables injured athletes to maximize their fitness
retention as they recover

Rejoyce allows clients to take

charge of their own recovery without
much supervision from others. The
Programme is based on few core
principles:
1. Simulates exercises that are used in
daily functions e.g. opening a door
using the handle
2. Games that promote intensive
training & motivation
3. Shows improvements of hand
functions in performing daily activities

Who is it for?
Any patient with shoulder, arm, and
hand weakness due to the following:
Stroke or acquired brain injury (ABI)
Cerebral palsy (CP)
Spinal cord injury (SCI)
Traumatic brain injury (TBI)
Other neurological injury

This equipment will revolutionize

rehab and its arrival coincides with
the increasing pressure to control
the healthcare costs by significantly
speeding up the recovery process.
Karen Brown, PT, Owner - Alliance Physical Therapy, NE

At present we are the

only Hospital in Penang
to have this facility

Assessment with the RAHFT

(Rejoyce Arm and Hand Function Test)

Rejoyces RAHFT takes a patient between 5 and

10 minutes to complete, and shows changes
of performance over time. Improvements in a
patients movement and speed are recorded
after each test. The software shows the progress
graphically and the information can be easily used
to assess the patients improvement and to further
motivate the patient psychologically.

i-exposure

Vol 15

Teach Your Child

to Listen

by Ms Chia Kien Eng

Consultant Speech
& Language Pathologist
/ Therapist
M.A. (U.K.) B.Sc (Glasg.),
MASH (Msia), M.R.C.S.L.T (U.K.),
Reg. OSLA (Canada)

Does your child have good listening

skills? Help your child learn to listen.
For speech and language to develop,
the ability to listen is by far the most
important skill a child must have. This
is different from hearing. A child may
be able to hear but he may not have
the ability to listen. If your child is
not responding to his name calls or
understanding you, make sure you
send your child for a hearing test.
When we say the child has the ability
to listen, it also means that the child
is able to understand what someone
says to them. This is called auditory/
listening comprehension which is
different from visual understanding.
Why is listening important? It is
one of the pre-requisites for language
learning. Children need to listen
and understand language before
they can speak. It is very common to
find children not developing speech
because their listening skills are poor.

What can a parent

do to help?

1
2

Reduce distractions and noise level

in the environment. Turn down the
TV, and radio to make sure that
your child can hear you.
Ensure eye contact and speak only
when the child looks at you. Give
clear instructions like Look at me
(point to your face at the same
time) before you speak.

3
4
5
6
7

Make every effort to call his name

to get attention. If the child
ignores his name, walk closely
towards the child and tap on
his shoulder.
Get the child to listen to
environmental sounds.
Talk about the sounds he hears
in the environment.
Encourage a lot of listening games
such as sound lotto (point to the
picture of what you hear), musical
statue (child runs and stops when
the music stops), posting game
(get the child to post each picture
card that he identifies) etc
Use short and simple language.
Speak slowly and clearly. Give one
direction at a time. Avoid speaking
too much and too quickly because
children tend to stop listening
when the message gets too hard
to understand.
Gradually increase the length
and complexity of your directions
for example, from following one
step command to two steps
command (Clap your hands and
shake your head).

8
9
10

Parents need to give the child time

to respond and think after each
direction or question. Practice
wait and listen yourself.
Create a daily quiet sharing and
listening time with your child.
Look and read through picture
and story books with him.
Give positive encouragement
and praise each time your
child listens well. Say thats
good listening or I like the
way you listen to motivate
the child to
listen well.

There are ways to check whether your

child has a listening comprehension
problem. Below is a guideline and
should your child experience a speech
and language delay because of
a listening comprehension problem,
it is advisable to see a speech and
language therapist for a full assessment.

12 - 18 months
Can identify and point to familiar
people and common objects
Can follow simple commands
clap hands
Points to some body parts

18 months - 2 years
Can relate to 2 similar objects
Comb babys hair
Can point to pictures in book when
named
Can follow one-step command
Get your shoes

2 - 3 years
Can follow directions involving
concepts of size, preposition,
Give me the big ball
Can follow 2 step command Get your
towel and put it in your bag
Can understand functions of objects
Which one is for drinking?
Follow very simple stories in books

3 - 4 years
Knows sex and full name
Can follow a variety of 2 step
command and some 3 step command
Stand up, clap hands and jump
Can follow instructions involving
several concepts Put the yellow
pencil under the big book
Answering who, why and where
questions

4 - 5 years
Follows more complex questions
What would happen if there is
no rain?
Develops reasoning ability If the boy
is thirsty, what does he want?

Before Standard One i.e. 7 years

Understands 20,000 to 26,000 words
Understands time and money concept
Understands simple addition and
E
subtraction
E

9 i-exposure

Vol 15

Siemens
Magnetom Spectra
3T MRI

by Prof. Dr Francis Lau

Diagnostic &
Interventional
Radiologist
MBBS (Mal), FRCR (UK), MMed
(Radiology)(UKM), AM

With this new 3T MRI scanner, we are

now able to provide high resolution and
detailed scans of the entire body.

First 3T MRI scanner in

the Northern region.
First Siemens
Magnetom Spectra
3T MRI installation in
South East Asia.
The Siemens Magnetom Spectra 3T MRI
scanner was fully installed and functional
in May 2013. We are proud to be one of
the first 3T MRI scanners in the northern
region of Malaysia as well as one of the
first installations in South East Asia.
The installation took a period of six
weeks with first preparation of the room,
followed by the RF (radio-frequency)
cabin, installation of the magnet,
computer cabinets and close of brick wall
and RF cage.

Why 3T?
Better image clarity and speed. Simply
put, the 3T system with its stronger
magnet field will increase the signal
available (which creates the image) and
the potential for better image clarity at
comparable scan speed. A similar analogy
is between HD (High Definition) and SD
(Standard Definition) television displays.

3T MRI results in an increase in SNR

(signal to noise ratio) of about twice
that of a 1.5T MRI. This gain in SNR can
be used to either improve image quality
or decrease the scan time in contrast to
1.5T imaging.
Another benefit of 3T MRI is an
improvement in image quality and
resolution. With 3T MRI, one can
choose to increase in-plane resolution or
decrease slice thickness. Increased SNR
and higher spatial resolution results in
improved image clarity and diagnostic
strength. Scanning with 3T MRI also
provides an increase in spatial and
temporal resolution. This results in the
ability to perform smaller FOVs (field of
view) and thinner slices as a result of
almost double the SNR compared to
1.5T MRI.
Decreased scan times can also be chosen in
3T MRI to help reduce data artifacts related
to patient motion in individuals who are
unable to or who have difficulty holding
still during the MRI process. This results
in a preservation of image quality and
resolution even at reduced imaging times.

An increase in chemical shift with 3T MRI

results in better MR spectroscopy (MRS)
imaging when compared with MRS at
1.5T, due to a doubling of chemical shift
with 3T MRI. This results in improved
spectral resolution or the ability to
visualize changes in peaks in metabolites.
Fat-water suppression techniques are
also improved at 3T. This is especially
beneficial for musculoskeletal studies in
which fat saturation imaging techniques
are important.
Advanced functional MRI sequences
are also possible with 3T MRI, including
diffusion weighted imaging (DWI),
diffusion tensor imaging (DTI) and blood
oxygen level dependent (BOLD) imaging,
all of which are much improved at 3T.

Summary
With this new 3T MRI scanner, we are
now able to provide high resolution
and detailed scans of the entire body,
especially in the brain, musculoskeletal
system and spine.

Installation of magnet
Installation of RF
(radio-frequency) Cabin

MRI room during installation

Crane used for lifting the magnet. Wall opening for entry of magnet

Fully installed Magnetom

Spectra 3T MRI machine
E

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Vol 15

10

Looking at
the Coronary Artery
from Inside-out
New information obtained by IVUS can
provide for more accurate stent placement,
reducing complications and the incidence
of stent blockages.

Since the first angioplasty performed

in 1977, major advances have taken
place in the last 3 decades resulting
in major refinement in this procedure.
Angioplasty is now the preferred
treatment modality in coronary artery
disease. Whilst major development has
occurred in stent technology, similar
advances have also taken place in the
imaging of coronary arteries. In this
brief article, I would
like to educate patients about the
advent of intravascular ultrasound,
a tool which complements an
angioplasty procedure.

What is IVUS?
Intravascular Ultrasound (or IVUS) allows
the Cardiologist to appreciate a coronary
artery from the inside-out. This unique
picture, generated in real time, provides
information beyond what is possible
with routine imaging methods, such as
coronary angiography, performed in
the cath lab.

by Dr Donald
Ang Swee Cheng
Consultant Cardiologist
MBChB (Dundee, UK),
MRCP (UK), MD (Dundee, UK),
CCST Cardiology (UK), Fellowship
in Advanced Interventional
Cardiology (Freeman Hospital,
Newcastle)

The pictures come from inside the heart

rather than through the chest wall. The
sound waves are sent with a device called
a transducer. The transducer is attached to
the end of a catheter, which is threaded
through an artery and into your heart.
The sound waves bounce off the walls of
the artery and return to the transducer
as echoes. The echoes are converted into
images on a television monitor to produce
a picture of your coronary arteries.
It gives us a cross-sectional view of
the artery, a view that shows different
circular layers, using shades of gray or
colors, the major ones being:

1. the adventitia
the outer covering of the artery

2. the media
the actual wall of the artery

3. the intima

Intravascular Ultrasound Catheter

This cross-section view of the artery can

help with sizing of stents (metal scaffolds).
It also confirms that the stent is placed
optimally and is fully expanded across the
vessel wall. There is growing evidence that
the new information obtained by IVUS
can make a significant difference in how
a patient is treated, and can provide for
more accurate stent placement, reducing
complications and the incidence of stent
blockages (whereby patients present with
heart attacks).

the layer cells that make direct

contact with the blood inside the
artery in normal arteries this layer
is thin; in narrowed arteries (shown
here) the intima is thickened by
plaques or other tissue growth,
often asymmetrical

4. the lumen
the actual open channel
of the artery through which the
blood flows

What is the mechanism of

this technology?
Intravascular Ultrasound Console

IVUS uses high-frequency sound waves

(also called ultrasound) that can
provide a moving picture of your heart.

Intravscular Ultrasound Image

cont. page 11

11 i-exposure

cont. from page 10

What is the difference

between IVUS and standard
angiography?
The current gold standard of invasive
angiography shows only the lumen,
as an X-ray shadow image created by
the injection of contrast dye (as seen on
the left).

by Intravascular Ultrasound. But the X-ray

angiogram only shows a side-view and
the unequal shape is not seen. Depending
on the angle of view, this may make the
artery look more blocked than it really is
or otherwise, may give a false impression
that the artery is only slightly blocked and
does not need to be treated. With IVUS,
just a few clicks on the machine measures
the area of the blockage, the size of the
artery and yields an accurate percentage
of narrowing.

When is IVUS indicated?

Intravascular Ultrasound is done in
the catheterization laboratory at the
same setting with angiography. Some
cardiologists use it occasionally, in complex
cases, or to assist in the selection of stents
and balloons. Others use it routinely,
to confirm accurate stent placement
deployment.

In certain situations, the additional

information provided by Intravascular
Ultrasound changes the picture of
the disease, and ultimately influences
treatment decisions. For example,
in a normal artery the intimal layer is thin
when measured, there is little difference
between the diameter of the lumen
(open channel) and the diameter of the
media (the arterial wall). In a blocked or
diseased artery, the intima is thickened by
plaques or other tissue growth, and the
lumen diameter is reduced.

How Can IVUS help

the Cardiologist during
Angioplasty?
One of the causes of stent blockages
or re-narrowing is under-expansion

Vol 15

the stent has not been expanded to the

full diameter of the artery, and this creates
an area where platelets and other debris
can collect, causing a re-blockage.
With precise measurements of the true
diameter of the artery provided by IVUS,
accurate sizing of the stent can be made.
Using only angiography, a cardiologist
may underestimate the size of a diseased
artery.
IVUS also gives an accurate measurement
of the length of the diseased artery. This
helps improve stent selection and reduces
the need for overlapping stents which
are known to increase the risk of stents
clotting.
Once the stent has been implanted, IVUS
can clearly show the stent struts in relation
to the arterial wall and plaque. If the stent
has been undersized or if there is any area
that needs touching up, a larger balloon
can be directed to it and expanded to fit
the stent optimally.
Modern IVUS systems are completely
integrated into the catheterization lab
and with proper training, the cardiologist
can add this new imaging technology to
a standard diagnostic angiogram with
a minimum of impact on the patient.

However, often the plaque or tissue

growth is not evenly distributed, resulting
in an unequal shaped lumen. This
unequal shape is clearly demonstrated

Appearance of cholesterol plaque in the coronary artery on IVUS

(marked green)

Appearance of an under-expanded stent (picture B) and a well-expanded

stent after balloon treatment (picture D) on intra-vascular ultrasound

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Vol 15

12

Angioplasty Using
ABSORB Vascular
Scaffold

The ABSORB vascular scaffold

is the worlds first successful
bioabsorbable scaffold.

In September 2012, I had the opportunity

to perform angioplasty on a patient from
Penang using the new vascular scaffold,
ABSORB by Abbott Vascular. The ABSORB
vascular scaffold is the worlds first
successful bioabsorbable scaffold made
available in Malaysia in the end of 2012.

Many patients have asked me about what

is so special about this bioabsorbable
scaffold as oppose to the normal stent.
There are many advantages naturally.
Firstly, no permanent implants mean
shorter duration of double blood thinner
medications. Instead of 1 year, it can now
be shortened to 6 months.

Angioplasty is a minimally invasive

procedure to unclog blood vessels of
the heart. The procedure involves putting
a small tube or catheter into the heart
via an artery at the wrist or the groin.
Subsequently, a balloon and usually
followed by a stent is inserted via this
catheter to the area of blockage. Once
the stent is implanted, it functions to keep
the blood vessel patent in order to allow
adequate blood flow into the heart.

Secondly, if renarrowing occurs in the

future, angioplasty can be done at the
same area again and again. With the
normal stent however, it is not advisable
to have too many layers of stents within
the same segment of blood vessel.
So, in younger patients (less than 65 years
old) who may need intervention again
in the future, the option of angioplasty
is still open to them.

Unlike a metallic stent which stays

permanently in the body, the ABSORB
scaffold resorbs naturally into the body
leaving no permanent implants. It is made
of a material called poly (L-lactide) or PLLA.
PLLA is the same material used in surgical
sutures to stitch up wounds.
As you may know, absorbable sutures do
not need to be taken out after surgery
because it resorbs naturally into the body.
Using this similar concept, cardiologists
and the medical device companies are able
to create such a device.

by Dr Chiew Kean Shyong

Consultant Cardiologist
MBBS (Mal), MRCP (UK),
FRCP (Edinburgh)

have appeared ie. the disappearing stent

(stent yang boleh hilang), the dissolvable
stent (stent boleh larut), and even
a stent that can turn into meat (jadi
daging). What ever my patients would
like to call it, they are happy with it. And
so far, from my records, my patients have
remained well and healthy with no major
complications.
In the future, there will be many other
types of the bioabsorbable scaffold
as medical device companies race to
produce and better one another. I believe
this would be the future of angioplasty
and one day, the metallic stents will be
replaced by bioabsorbable scaffolds.

So, what happens when the scaffold has

disappeared? Many studies have shown
that even when the scaffold has resorbed,
the blood vessel will remain patent.
Not only that, the inside of the blood
vessel enlarges to allow better blood flow.
This phenomenon has never been seen
before with the more rigid metallic stents.
Currently, there are many patients locally
and from overseas who have enquired and
quite a number have had this new scaffold
implanted. Many monikers of this scaffold

Also, similar to the drug eluting stents,

the scaffold is coated with a similar dose
density of everolimus, a drug coated on
the surface of the stent / scaffold to reduce
the incidence of renarrowing.

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Vol 15

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Vol 15

14

Revealing Your New

Confidence and Beyond
with Plastic Surgery
There are many reasons why people are
seeking aesthetic procedures and surgery.
The decision is rather personal.

Reconstructive Surgery
The specialty of plastic surgery started
with reconstructive surgery for
congenital abnormalities and acquired
injuries since 800BC. Reconstructive
surgery, as the name suggests, is
a surgical sub-speciality to restore
and correct deformities that are due
to congenital anomalies, trauma,
infections, tumour excision and
degenerative processes, including
closing defects using skin grafts, local
flap, regional flaps or distant flaps.
Reconstructive surgery has seen a fast
advancement since World War II as
there were demands for correction
deformities due to war injuries.
Reconstructive surgery aims to restore
the functions of the body parts and,
at the same time, to restore the forms
and appearance from abnormal
towards normal. Plastic surgery can
be considered the surgical counterpart
of dermatology where skin from face
to toes is the main area of practice.
Common reconstructive surgery include:
Cleft lip and palate repair

Dr Darren Khoo Teng Lye

Consultant Plastic &
Reconstructive Surgeon
M.D., Master of Surgery
(Plastic Surgery), FADUSM, AMM,
Dip. AAAM(USA), Fellowship
in Oculoplastic and Aesthetic
Surgery (DCUMC, Korea)

Aesthetic Surgery

Skin birth marks (Haemangioma,

Vascular Malformation)
Keloid and hypertrophic scars treatment
(Non-surgery and Surgery)

Skin Cancer Excision and

Reconstruction
BEFORE

AFTER

Surgery for purely aesthetic reasons was

incorporated into the field of plastic
surgery somewhat later. It has
undergone an estimated five-fold
increase in turnover in a decade.
Aesthetic surgery aims to enhance
the apperance of the average people
to attractive ones. Research from the
American Society for Aesthetic Plastic
Surgery (ASAPS) has shown that
societal acceptance of plastic surgery
is increasing. The International Society
of Aesthetic Plastic Surgeons (ISAPS)
reported that 15 million people across
the globe had resorted to plastic surgery
in 2011 in a quest to achieve the perfect
look. The U.S. had most procedures but
South Korea had the highest proportion
of its population having surgery. Twenty
percent of women aged 19 to 49
in Seoul admitted to have plastic
surgery in 2011. Double eyelids surgery
was one of the most popular surgical
procedures.

Now Everyone Can Look Good

There are many reasons why people are
seeking aesthetic procedures and
surgery. The decision is rather personal.
Some would like to look young,
beautiful and impressive. Others would
like to change a body or facial feature
that they have dreamt of changing
since young. The improved appearance,
better sense of well-being and regained
self-confidence give them advantages
in terms of getting into a relationship,
accepted for a job interview, higher
chances of promotion, or just to be the
centre of attention in a group of peers.

Keloids Scar Excision

BEFORE

Facial soft tissue injury and facial

fractures
Complicated wounds management and
reconstruction
Face, head and neck reconstruction
External ear reconstruction and
otoplasty
Breast reconstruction for breast cancer
Congenital hand anomalies
Burn care and surgery
Benign and malignant skin tumours
treatment
Excessive sweating and unpleasant
body odor (Hyperhidrosis and
Osmidrosis) treatment

AFTER

Eyelid Aesthetic Surgery

Eye contact is important in our daily
interaction. Eyelid aesthetic surgery
is one of the most common aesthetic
procedure for those who strive for
bigger and rejuvenated eyes. Getting
your lower, upper or both eyelids
refreshed can make a dramatic
difference and impact on how you
look and feel.
cont. page 15

15 i-exposure

cont. from page 14

Eyelids Rejuvenation
Lower eyelid procedures
Eye bag removal
Lower eyelid skin tightening and
wrinkle removal (both surgery
and non-surgical methods)
Upper eyelid procedures
Eyelid lift surgery
Removal of excess skin
Eyebrow lifting

Vol 15

Nose Shaping Surgery

3-Dimensional
Augmentation
Our nose, as the central and most
prominent structure of the face, has
a major impact on a persons first
impression. A high and 3 dimensional
nose is an identity of attactiveness for
women and a symbol of confidence
and sophistication in men.

Big Eyes Surgery

Double
eyelid
creation

Drooping
eyelid
(Ptosis)
correction

Non-surgery Facial
Rejuvenation
Laser Facial Resurfacing
Pigmentation, wrinkles, acne scarring
Facial Filler Augmentation
(Hyaluronic Acid Filler)

Lateral
canthoplasty
(Outer eyelid
enlarging
surgery)

Medical
epicanthoplasty
(Inner eyelid
enlarging
surgery)

Botulinum Toxin A for facial wrinkles

obliteration
Masseter Muscle Reduction
Thread Lift
Chemical Peels
Platelet Rich Plasma application

Lower
eyelid
correction

Love band
creation

Nose Shaping Surgery

AFTER

Nasal bridge augmentation

Nose profile correction
(smoothen visible humps or
depressions on the bridge)
Nasal asymmetry and deviation
correction

Facial slimming and tightening

with radiofrequency devices

Minimally Invasive Facial

V-line Surgery
Micro-fat Graft Transfer with
Stem Cells
Facial Implant Augmentation
Face Lipolysis
Mini Face Lift
Neck Lift
Lip augmentation and reduction
Cheek dimples creation

Short nose lengthening

(increase or decrease
the nose size)
Nasal tip shaping (large or
bulbous, drooping or too
upturned nasal tip)
Nasal base reduction
(nastrils that are large,
wide or upturned)

Conclusion
Although plastic surgery may achieve
wonders in correcting unwanted
deformities and improving desired
physical attractiveness, it is important
to seek treatment from experienced
surgeons in a well-equipped medical
centre to ensure the best possible
outcome.

BEFORE
E

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Vol 15

16

BD SurePath - New
Liquid Based Cytology
Pap Smear Test
BD SurePath liquid based cytology
is a thin layer technology that provides
a more uniform slide for screening.
It improves the Pap tests sensitivity up
to 95% as compared to conventional
Pap Smear. The BD SurePath Pap test
consists of the SurePath fixative media
for sample collection combined with the
BD Prepstain Slide Processor.

SurePath Specimen Collection

SurePath Pap test uses a process that
standardizes cell collection with either
a single-pass broom-type collection device
or a combination of a plastic spatula
and endocervical brush. Each of these
collection devices is equipped with
a detachable head. The SurePath liquid
media has a cellular sample stability
of 4 weeks at room temperature and
6 months refrigerated. The residue can
be retained for additional testing
(HPV, cell blocks, etc).

SurePath Specimen
Processing
SurePath slide production begins with an
enrichment process, which combines a
variety of steps, including homogenization
of the sample, and gravity dispersion and

density gradient centrifugation to prepare

a processed cell pellet to be placed on the
PrepStain Slide Processor. The Prepstain
instrument then completes the process
with automated pipetting for gravity
sedimentation to produce a thin-layer slide
preparation, follow by batched automated
Pap staining.

Advantages of SurePath
Liquid Base Cytology
The BD SurePath test has an FDA approved
claim for a 64.4% increase in HSIL+
detection over conventional Pap test. Over
a 10 year period, the BD SurePath test
produced better HSIL+ detection than
ThinPrep.

by Ms Ooi Gaik Teng,

CT (IAC)

Senior Cyto-Histo
Technologist
(Pathologist Dept.)

The SurePath Pap test provides

an increased detection of HSIL+
and a significant reduction of
unsatisfactory specimen.
The BD SurePath proprietary cell enrichment
process separates and reduces obscuring
material such as blood, mucus and
inflammatory cells, minimising the risk of
missing disease. SurePath preparations are
more efficient in handling excessive blood.
Thin Prep methods become compromised
with as little as one drop (50l) of blood,
reducing diagnostic cellularity.

SurePath vs ThinPrep in
Handling Excessive Blood
SurePath

Added packed
erythrocyt
0 L

The heads of SurePath devices are

detached and deposited into the vial,
100% of the collected sample can be sent
to the lab for processing. For conventional
Pap test, average 30% of the sample
collected was discarded, which could
mean the difference between finding
an abnormality and missing it.
The BD SurePath Pap test is the liquid base
cytology with an FDA approved claim for
lowering an unsatisfactory rate repeatedly
proven in many clinical studies. It is 8.9
times more likely to be satisfactory than
Thin Prep specimen.

Thin Prep

50 L
250 L
1000 L

From clinical trial data, the FDA has

recognized via the labeling process
that the SurePath Pap test provides an
increased detection of HSIL+ and a
significant reduction of unsatisfactory
specimen in comparison to Thin Prep and
conventional Pap smears.
E

Sample Collection
Using Rovers Cervex-Brush with
Detachable Head

ent
Cell Enrichm

Process

17 i-exposure

Vol 15

Getting to Know our New Consultants

Consultant
Haemato- Oncologist

Consultant
Urologist

Dr Saw Min Hong

Datuk Dr Liong Men Long,

DMSM

(MBChB (Edin), MRCP (UK), FRCPath (UK)

MBBS (Mal.), FRCS (Edin.), FRCS (Glasg.)

ESMO (Cert.)

Tel: +604 238 3426 / 3427 (Direct Line)

Tel: +604 238 3475 / 3476 (Direct Line)

Ext: 6209 / 6210

Ext: 6222 / 6223

Consultant
Neurologist

Consultant
Neurosurgeon

Dr Lim Thien Thien

Mr Lee Hock Keong

MBBS (UM), Masters in Surgery
(Neurosurgery) (USM)

MD (UNIMAS), MRCP (UK), Fellowship

in Parkinson Disease & Movement Disorder
(Cleveland Clinic, USA)

Tel: +604 238 3360 (Direct Line)

Tel: +604 238 3434 / 3435 (Direct Line)

Ext: 5056 / 5562

Ext: 5031 / 5032

Sementara kelebihan berat badan (overweight) adalah keadaan

dimana berat badan seseorang melebihi berat badan normal.
Obesitas dapat terjadi disebabkan karena antara lain terjadinya
ketidakseimbangan antara energi yang masuk dengan energi yang
keluar. Indeks Massa Tubuh (IMT) atau Body Mass Index (BMI)
telah diakui sebagai cara yang paling praktis dalam menentukan
tingkat kelebihan berat badan dan obesitas pada orang dewasa di
bawah umur 70 tahun.
Indeks massa tubuh adalah perhitungan yang dilakukan untuk
mengetahui apakah Anda termasuk dalam berat badan normal,
kurang, atau berlebih (obesitas).
Indeks Massa Tubuh dapat kita hitung sendiri dengan rumusan :
Acapkali obesitas atau kegemukan memiliki pengertian yang
berbeda-beda bagi setiap orang. Namun secara pengertian umum
obesitas bermakna kelebihan berat badan yang jauh melebihi
berat yang diinginkan.
Tidak jarang kita sering dibuat bingung dengan pengertian
obesitas dan kelebihan berat badan, padahal kedua istilah
tersebut memiliki pengertian yang berbeda satu sama lain.
Obesitas (kegemukan) adalah suatu keadaan dimana terjadi
penumpukan lemak tubuh yang berlebih, sehingga berat badan
seseorang jauh di atas normal dan dapat membahayakan
kesehatan.

IMT di Indonesia:

Berat Badan (kg)

IMT =

Tinggi Badan x Tinggi

Badan (meter)

Nilai IMT < 18,5 = Berat badan kurang

(underweight)
Nilai IMT 18,5 - 22,9 = Normal
Nilai IMT 23,0 - 24,9 = Normal tinggi
(overweight)
Nilai IMT 25,0 - 29,9 = Gemuk
(obesitas 1)
Nilai IMT 30,0 = Sangat gemuk
(obesitas 2)
Nilai BMI yang didapat tidak tergantung
pada umur dan jenis kelamin.

i-exposure

Vol 15

18
Namun keterbatasan IMT adalah tidak
dapat digunakan bagi anak-anak yang
dalam masa pertumbuhan, wanita
hamil, serta orang yang memiliki
volume otot banyak, contohnya atlet.

Tubuh Subur Belum Berarti Sehat

Stigmatis publik pada figur bentuk tubuh manusia kurus selalu

dikonotasikan representatif personal yang selalu dalam kondisi
tertekan atau stress. Belum tentu. Justru stress atau depresi
adalah pemicu obesitas dan kelebihan berat badan.

Dimana aspek fleksibilitas tersebut sedikit banyak mempengaruhi

tekanan darah dan juga perkembangan hipertensi. Kurang lebih
46% pasien dengan nilai Indeks Massa Tubuh mencapai 27
adalah penderita hipertensi.
Framingham Studi telah menemukan bahwa peningkatan 15%
berat badan dapat menyebabkan peningkatan tekanan darah
sistolik sebesar 18%. Dibandingkan dengan mereka yang
mempunyai berat badan yang normal, orang yang memiliki
kelebihan berat badan sebesar 20% mempunyai resiko delapan
kali lipat lebih besar terhadap hipertensi.
Beberapa penyakit yang terpicu dari obesitas diantaranya:
Penyakit Jantung Koroner (PKH) / Coroner Heart Disease
(CHD)
Kurang lebih sebanyak 40% kejadian penyakit jantung koroner
terjadi pada seseorang dengan nilai Indeks Massa Tubuh di atas
21, namun tidak menutup kemungkinan penyakit ini sebetulnya
dapat dicegah.
Stroke
Kelebihan berat badan merupakan faktor resiko utama terhadap
stroke. Kegemukan (terutama di sekitar perut/abdomen) dapat
meningkatkan resiko stroke (kondisi ini tidak tergantung besarnya
nilai Indeks Massa Tubuh).
Penyakit Kantung Empedu
Obese cenderung lebih mudah terkena batu empedu.

Orang yang mengalami obesitas cenderung memiliki kadar stress

lebih besar dibandingkan orang yang memiliki berat badan dalam
kategori normal. Makanan berlemak ternyata meningkatkan stress
dan lebih cepat berpengaruh kepada orang yang bertubuh gemuk.

Obesitas & Komplikasinya

Seperti yang kita ketahui, kondisi stress yang menahun dengan

frekuensi interval tinggi sangat bisa memicu beberapa penyakit
mematikan seperti antara lain kanker dan penyakit jantung serta
bahkan stroke. Dimana dalam kasus ini secara khusus memiliki
korelasi langsung dengan gejala hipertensi.
Penjelasan mekanisme hal tersebut dikarenakan obesitas
merupakan suatu faktor utama yang bersifat fleksibel.

Osteoarthritis (OA)
Kelebihan berat badan berhubungan dengan OA pada sendi
tangan dan lutut. Bagaimanapun, keterbatasan kemampuan
berolah raga pada pasien OA sedikit banyak juga mengambil
peranan terhadap timbulnya kelebihan berat badan.
Kanker
Obesitas dapat meningkatkan resiko terhadap penyakit kanker
tertentu. Suatu studi yang dilakukan oleh American Cancer
Society menjelaskan bahwa kematian yang diakibatkan oleh
kanker prostat dan rektal-colon (colorectal) meningkat pada
laki-laki obese, sedangkan kanker endometrium, uterus, mulut
rahim (cervix), dan indung telur (ovarium) meningkat pada wanita
obese. Dibandingkan wanita dengan berat normal pada masa
post-menousal, wanita obese mempunyai resiko yang lebih tinggi
terhadap kanker payudara.
Kelainan (gangguan) lain
Obesitas juga berhubungan dengan varieses vena, beberapa
gangguan hormonal dan infertilitas.
Selain itu, kelebihan berat badan dan obesitas erat hubungannya
dengan peningkatan resiko sejumlah komplikasi yang dapat
terjadi sendiri-sendiri atau secara bersamaan.
Seperti yang telah disebutkan di awal, morbiditas itu dapat
berupa tekanan darah tinggi atau hipertensi, kelainan fraksi lipid
atau dislipidemia yang diindikasikan dari kenaikan kadar kolesterol
total, penyakit jantung atau penyakit kardiovaskular, stroke,
diabetes tipe II, penyakit gallblader atau penyakit di kandung
empedu, disfungsi pernafasan, penumpukan kristal asam urat
di jaringan dan persendian tubuh atau gout, nyeri sendi atau
osteoarthritis, dan beberapa jenis kanker tertentu.
Namun penyakit kronik yang paling sering menyertai obesitas
adalah diabetes tipe II, hipertensi, dan hiperkolesterolemia yang
merupakan implikasi lanjutan dari dislipidemia.
Data dari NHANES (National Health and Nutrition Examination
Survey) III, 1988 1994, memperlihatkan bahwa dua pertiga pasien
obese dan overweight dewasa (nilai Indeks Massa Tubuh : 27)

19 i-exposure
mengidap paling sedikit satu dari banyak penyakit kronik tersebut
serta 27% lainnya dari mereka mengidap dua atau lebih penyakit.

Lalu Bagaimana?

Seseorang menjadi obese tidak hanya disebabkan oleh satu

faktor, melainkan justru terpicu dari berbagai macam aspek,
termasuk faktor diet, faktor gaya hidup, faktor kebudayaan,
faktor genetik, faktor jenis kelamin, dan faktor pola kebiasaan.
Namun faktor yang paling banyak memiliki substansi pemicu
adalah pemilihan gaya hidup. Makanan siap saji (fast food),
peralatan yang mempermudah kerja hingga menciptakan
kebiasaan pola kerja yang inaktif dapat juga membuat tubuh kita
menjadi gemuk.

Vol 15

sekarang selain tepung, juga banyak

dinambahkan margarine, minyak dan
jenis lemak lainnya.
Seperti telah diketahui, lemak
merupakan penghasil kalori terbesar
tiap gramnya, dibandingkan sumber nutrisi lainnya seperti
halnya karbohidrat dan protein.
Maka tidak heran, bila asupan lemak yang tinggi merupakan
penyebab terjadinya kelebihan asupan energi, yang bila
tertimbun dapat menimbulkan kelebihan berat badan. Dari
hasil pengamatan terlihat bahwa seseorang dengan kelebihan
berat badan sangat suka makanan berlemak. Rata-rata
konsumsi lemak mereka berada di atas 50% dari total kalori.
Proses pencernaan dimulai di mulut, dimana makanan dirubah
menjadi bentuk yang lebih kecil, kemudian diteruskan ke
lambung. Dengan bantuan enzim, makanan di lambung
dipecah menjadi komponen-komponen penyusunnya, seperti
protein, karbohidrat, dan lemak.
2. Kurangi asupan kalori per hari dari pola makan biasanya
(kurang lebih 600 kkal). Tubuh selalu memerlukan asupan
nutrisi dasar, tidak selalu dari kuantitas asupan yang banyak.
Namun lebih efektif didapat dari pola makan yang berkualitas.

Para ahli setuju bahwa di kehidupan masyarakat yang modernstress dan pola makan gaya hidup modern seperti halnya
mengkonsumsi makanan siap saji ataupun tidak mempunyai
waktu berolah raga dan lainnya memicu terjadinya penumpukan
lemak tubuh secara berlebihan.
Terapi tingkah laku adalah suatu metoda yang digunakan untuk
mangatur ataupun memodifikasi pola makan dan aktifitas fisik
dengan olahraga pada pasien obese.
Dengan demikian, terapi tersebut diharapkan dapat mengatasi
hambatan-hambatan terhadap kepatuhan pasien pada pola makan
sehat dengan menempuh cara terapi diet dan ataupun olahraga.
Strategi-strategi terapi ini adalah sebagai berikut: penilaian diri
sendiri atau self-monitoring, kontrol stress, kontrol rangsangan
(stimulus), pemecahan masalah, penatalaksanaan darurat atau
contingency, perombakan kognitif (cognitive restructuring), dan
dukungan sosial. Satu hal yang perlu diingat adalah strategistrategi tersebut harus dibuat personal yang disesuaikan dengan
kebutuhan pasien bersangkutan yang menyangkut strategi untuk
diet dan olah raga.
Perubahan yang drastis pada seorang pasien dengan pola makan
normal memang sangat sulit, perasaan terhadap perampasan
kesenangan yang pada akhirnya dapat menimbulkan frustasi.
Pada kebanyakan kasus dapat menimbulkan peningkatan kembali
berat badan.
Berikut petunjuk membantu solusi obesitas:
1. Makan lebih sedikit lemak maksimal 30 % dari keseluruhan
jumlah kalori yang dikonsumsi. Mengurangi lemak akan
mengurangi asupan kalori dan memperbanyak turunnya
berat badan. Hal itu juga dapat membatasi atau mencegah
timbulnya efek salah makan. Karena lemak adalah sumber
kalori terbesar.
Menu makanan sekarang jelas jauh berbeda dengan menu
makanan pada era terdahulu. Jika era dulu makanan lebih
banyak mengandung karbohidrat seperti halnya kuekue dengan bahan utama hanya dari tepung, era modern

Zat gizi utama yang dibutuhkan oleh tubuh adalah protein,

karbohidrat, dan lemak. Zat-zat gizi tersebut menempati porsi
vital yang dibutuhkan untuk metabolisme, membangun dan
memperbaiki sel-sel tubuh, dan untuk mendapatkan energi.
Selain zat gizi utama tadi, tubuh juga memerlukan mineral
dan vitamin untuk mengatur cairan (elektrolit) tubuh,
pertumbuhan tulang, pembentukan sel-sel darah, membantu
proses metabolisme dan membentuk hormon / enzim
3. Mengkonsumsi makanan dengan gizi seimbang, paling sedikit
3 kali sehari. Memilih makanan dan minuman secara hati-hati
akan membantu anda mengontrol kalori dan jumlah lemak
total, lemak jenuh, kolesterol, garam, gula dan minuman
beralkohol.
4. Perbanyak aktifitas. Sebelum anda melakukan perubahan
apapun pada diri anda, pastikan bahwa hal itu akan
bermanfaat. Meningkatkan aktifitas fisik secara umum seperti
berolahraga selama 20 menit dapat menurunkan tekanan
darah, mengontrol diabetes, menurunkan kadar kolesterol
serta mengurangi komplikasi kesehatan lainnya yang
berhubungan dengan kelebihan berat badan. Jelas lebih baik
daripada anda menghabiskan 2 jam menunggu di salon atau
di bengkel.
Dengan latihan secara teratur umumnya lebih berhasil
menurunkan berat badan dan mempertahankannya
dibandingkan dengan orang yang tidak berlatih secara
teratur. Serta tak luput konsultasikan dengan dokter atau
pakar-pakar terkait terlebih dahulu sebelum anda memulai
program olah raga.
Satu hal yang perlu dan penting diingat, satu-satunya jalan
untuk menurunkan berat badan adalah untuk penggunaan
energi yang lebih banyak daripada energi yang dikonsumsi.
5. Dan yang terakhir adalah kebulatan tekad. Diperlukan
kegigihan usaha dari pelaksanaan niat yang ditanamkan.
Bulan puasa ini adalah momentum tepat untuk
mengimplementasikan usaha ini.
Sumber: Klikdokter

20 i-exposure

Amankah
Operasi Plastik?
BEDAH plastik
merupakan cara
yang efektif untuk
memperbaiki
cacat karena
penyakit atau
memperbaiki
tubuh yang sudah
baik menjadi lebih
baik, akan tetapi,
bedah plastik di
luar standar bisa
mendatangkan,
memperburuk
penyakit bahkan
mengakibatkan
kematian.
Bedah plastik, efektif untuk merekonstruksi bagian tubuh
akibat penyakit seperti perbaikan bekas luka operasi, trauma
kecelakaan, cacat lahir, hemangiom/tumor yang ada di pipi serta
perbaikan payudara pasca tumor. Selain itu, bisa juga untuk
fungsi estetis seperti perbaikan kelopak mata, pembentukan pipi,
dagu, hidung, tarik mata, membuang tato, sedot lemak, serta
memperbesar atau mengecilkan payudara.
Oleh karena itu, bedah plastik semakin banyak digemari baik oleh
laki-laki maupun perempuan dari berbagai kalangan, mulai dari
artis, para politisi serta masyarakat pada umumnya. Keinginan
untuk tampil cantik, seringkali membuat orang menempuh jalan
pintas, melakukan bedah plastik atau suntik silikon tanpa melalui
prosedur standar dan tanpa ditangani oleh dokter spesialis yang
bersertifikasi.

Vol 15

Operasi plastik semakin banyak

menimbulkan korban, hal ini karena
orang ingin tampil cantik dengan cara
yang cepat dan biaya murah,
Penggunaan silikon, merupakan salah satu penyebab
timbulnya banyak korban. Penanaman kantung silikon di
bawah kulit tidak menimbulkan masalah, asalkan memilih silikon
yang bisa berteman dengan tubuh.
Ada bermacam-macam silikon, silikon padat berupa lembaran
untuk memperbaiki struktur luka, silikon khusus dagu/hidung,
silikon pipi, silikon berbentuk gel untuk payudara. Tetapi, pada
prakteknya, yang sering digunakan adalah silikon dalam bentuk
cairan minyak, yang hanya pantas untuk mesin bukan untuk
manusia.
Suntikan silikon cair ini akan mengakibatkan infeksi yang tidak
bisa disembuhkan, menyebabkan kulit memerah, mengeras dan
membatu. Yang lebih parah, silikon yang disuntikkan ke payudara
akan bercampur dengan jaringan payudara sehingga tidak dapat
dibedakan, cairan ini akan bereaksi dengan tubuh dan perlu
waktu bertahun-tahun untuk mendeteksinya. Penyuntikan dalam
kadar tinggi, akan mengakibatkan kematian.
Oleh karena itu, silahkan melakukan bedah plastic, tetapi melalui
standar yang tepat dan dengan dokter spesialis yang ahli di
bidangnya.
Untuk keterangan lanjut silalah hubungi
Customer Service Dept.,
RS Island Hospital, Penang
E-mail : info@islandhospital.com
Sumber: Klikdokter
Dengan kerjasama Dr. Darren Khoo
(Dokter Pakar Bedah Plastik & Kecantikan,
RS island Hospital, Penang)

In-house Antenatal Classes 2014

Consultant Obstetrician
& Gynaecologist

Date for the Antenatal Class 2014

Session 1

Session 2

Session 3

15 Feb 2014

22 Feb 2014

1 Mar 2014

Dr Narinder Singh

12 Apr 2014

19 Apr 2014

26 Apr 2014

Dr Mahalakshmi

21 Jun 2014

28 Jun 2014

5 May 2014

Dr Eric Soh

9 Aug 2014

16 Aug 2014

23 Aug 2014

Dr Mah Siew Lee

11 Oct 2014

18 Oct 2014

1 Nov 2014

Dr J. Karen

EE
OMMITT: Ch
ETTER Cmm
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ristine Ooi
ary
ret
Sec
e
itte
Co
ra Hamid

Interested in joining us? Call our Customer

Service at 04-2288 222 ext. 5043.

an Tan,
Chairman: Puan
Lim, Leong Kar Hing, Lili
Chew, Dylin Loh, Grace
g
on
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uah
Ch
,
Lim
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Loo
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, Supanee Sararaks, Vincy
Foong Ling, SN Lim Ee Lin
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