Thirty-five patients with blunt hepatic injuries treated in a 7-year period are reviewed. The difficulties of diagnosis are stressed in that only 48.6%c were diagnosed
preoperatively. Associated intra-abdominal and concomitant head, chest, pelvic and skeletal injuries accounted for most of these difficulties. Seventeen of the 35 patients had extensive lacerations or intra-lobar ruptures of the liver. Simple linear or stellate lacerated wounds were treated by drainage, or suture, or debridement of the ragged liver edges and suture. Prior to 1964 extensively lacerated liver wounds were treated by gauze packing. Three (60%c) of five patients thus treated died, while the others had multiple complications. Since 1964, packing has been abandoned in favor of major resection and of 11 patients who underwent such procedures only one died. Hepatic resection for severe blunt injuries has the advantages of removal of all devitalized liver, control of hemorrhage, reduction of postoperative complications such as secondary hemorrhage, intraabdominal and hepatic abscesses and hemobilia. Hepatic resection is recommended for subeapsular hematomas with intra-lobar rupture of the liver to avoid hepatic necrosis. These injuries are diagnosed by injection of methylene blue into the common hepatic duct. Low mortality and morbidity in this series is due to improved care of injured pa-tients, early surgical intervention and adequate removal of devitalized lacerated and injured tissues by debridement or major hepatic resection.
Fifteen patients with pure lepromatous leprosy were treated for 12 months with DDS at 50 mgm. twice weekly. The drug was fully effective in this dose, and the incidence and severity of ENL were not less than on larger doses
Epidemiological studies of human leptospirosis have generally been limited to countries with specialized laboratories employing the microscopic-agglutination (MA) test. The sensitized-erythrocyte-lysis (SEL) test is much simpler for routine hospital laboratories to carry out and it has been found valuable in the diagnosis of human leptospirosis. This paper reports the results of studies of the SEL test as an epidemiological tool in serological surveys.The results showed that the significant SEL titre was 1:80 and that the sensitivity of the test depended possibly on the antigen preparation and the amount of complement used. Most of the SEL antibodies were found to persist at significant titres for about 1 year after active infection, but less than half persisted longer than that. The SEL test is therefore useful for detecting recent infections and for indicating that stability of leptospirosis in an area.The endemicity of leptospirosis in West Malaysia was confirmed by the SEL test, based on the employment of 1:80 as the significant titre.
The immunisation-rate of infants in Malaysia is low, and diphtheria and tetanus are common. If a satisfactory level of population immunity is to be achieved, many more infants must attend clinics more often, or other forms of immunisation must be offered. However, a mathematical model shows that the immunisation-rate can be improved immediately,
without the need for additional staff or increased attendance of infants at clinics, by giving some immunisations in the immediate postnatal period and the remainder soon afterwards. Many of the infants who came to the clinics had minor infections. The model shows that the immunisation-rate would increase further still if immunisations were given in the presence of these infections. It is possible that earlier immunisation may give lower levels of immunity in individuals, but the increased numbers immunised would more than compensate for this.
MeSH terms: Ambulatory Care Facilities; BCG Vaccine; Child Health Services*; Child, Preschool; Diphtheria/prevention & control; Humans; Immunization; Immunization Schedule*; Infant; Infant, Newborn; Malaysia; Maternal-Child Health Centers; Methods; Models, Theoretical; Tetanus/prevention & control