Here is the reason that children in Malaysia are getting Hepatitis B vaccination.

The AFP (alpha-fetoprotein) was more than 350mg/L.
Hepatitis B surface antigen serology was positive.

A forty-something-year-old man presented with abdominal pain for the previous few weeks. He had history of being a Hepatitis B carrier but was not on a surveillance program. He was not jaundiced. Abdominal examination detected localised tendernass. The CT scan shows a mass in the right lobe of the liver.

The red line marks the tumour. The yellow line marks the rest of the (normal) liver.

“Surveillance” is the serial follow-up of patients who are at high risk of developing further problems. For example, Hepatitis B patients are at high risk of developing liver cancer. All patients with chronic Hepatitis B infection should be on a surveillace program. For those with neither Hepatitis B infection nor immunity, i.e. Hepatitis B surface antibody is negative, get vaccinated.

When I posted the hiatus hernia last week, some people couldn’t see what I meant by the mucosa hugging the scope. Here another scope view that shows you the mucosa hugging the scope. This is a normal view of the junction between the esophagus and the stomach from below. The black tube is the scope and it has turned back to look at itself passing down thru the junction.

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Here’s a view marked with red for the mucosa and blue for the scope.

Compare that with a hiatus hernia.

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I was debating whether I should put this up, but then I think that I should share with all those in the nearby area that there will be a cancer screening week here:

From 18th March to 27th March 2007 from 9.00 am to 5.00 pm. Screening tests will be offered at reduced rates during this period.

Cancer	Suggested to attend screening	Test
Breast	Women aged 40 and above	Mammography
Cervix	All sexually active women	Pap Smear
Colon and rectum	Anyone aged 50 and above	Colonoscopy
Liver	Hepatitis B and C carriers	Ultrasound and AFP blood test
Nasopharynx	Aged 40 and above, particularly Chinese male	Nasal endoscopy and EBA VCA IgM blood test
Prostate	Men aged 45 and above	Digital Rectal Exam and PSA blood test

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Update:

I’ve taken out the price column. I’m posting the info here because it’s cheap but you should call to check that out if you are interested for yourself or your family : 04-4428888.

This campaign was organised by the SP division of Wanita MCA on 9th March 2007

The breast cancer incidence for Malaysian Chinese in the year of 2003 was 59.7 per 100,000. The rate in Indians was 55.8 per 100,000 and in Malays, it was 33.9 per 100,000.

A sixty-something year old man had history of change in bowel habit since Ramadan last year. He had put up with the difficulty in passing motion and passage of mucus with the stools for some time, thinking that it would go away. Everyday, he went to toilet with the hope that it would be normal stool today. But the stool was just as difficult to pass. All he could manage was mucus and a small amount of blood. Once in every few days, he passed some liquid stools. Now that he was having abdominal pain, he came to see a doctor.

Upon hearing the history, the doctor feared the worst. The diagnosis was half-made even before examining the patient. He probed for other medical history before setting the patient on the examination couch. He went through the preliminary general examination looking for signs of anaemia and jaundice; fortunately neither was present. The abdominal examination was unremarkable. The liver was not enlarged; and there was no sign of abdominal distension or bloating.

At last he came to the crunch. This he could not, no, must not miss. Gently he turned the patient over to the left and exposed the anus. Gloving up, he reassured the patient and applied a blob of lubrication gel on the right index finger. Pressing the tip of the finger against the edge of the anus, he waited while the anus relaxed and allowed the finger to slip into the opening. His worst fear was confirmed.

The examining finger encountered a solid lump in the rectum. It was huge and it was attached to the rectal wall by a broad base. The base was at the “6 o’clock” position, he noted, meaning that it was at the back wall of the rectum. “12 o’clock” meant the front wall of the rectum. The tip of the finger couldn’t feel the upper border of the lump. It was extending too high up. He nudged the base of the lump… at least it was able to move. “Good, not stuck to the structures beyond the layers of the rectum”, he thought.

With the finger still in the rectum, “Teran sikit”. The patient contracted the anal sphincter muscle. He felt them squeeze his finger. OK, they were working well. Satisfied that he had found out all that he wanted to know, he slipped the finger out and de-gloved. Some laxatives were prescribed to induce diarrhoea (bowel preparation) so that the colon would be ready for colonoscopy the next day.

What he found was worse than expected:

The rectal tumour. Looking angry.