Three cases of schistosomiasis in 2 Filipinos and one Chinese in Sabah are reported. Diagnosis was based on incidental histological findings of Schistosoma japonicum-like ova in the liver and rectal biopsies. As these 3 patients are immigrants to Sabah, it is assumed that they are imported cases, and that Sabah has been free of the disease from 1970 to 1977.
Between 1967 and 1976, 388 cases of lung cancer were seen at the University Hospital, Kuala Lumpur, with histological confirmation in 72%. Most were aged from 50--80, with a male to female ratio of 2.8 : 1. The patients were predominantly of Chinese origin (82%) and from the lower socioeconomic strata. A history of smoking was elicited in 78%. The chief clinical and radiological features and the diagnostic methods are presented. The incidence of the histological types was squamous carcinoma 34%, adenocarcinoma 25%, large cell carcinoma 12%, small (oat) cell carcinoma 12%, "unidifferentiated/anaplastic" 15%, and others 2%. Malays appeared to have a higher percentage of adenocarcinoma. A comparison between the histologically confirmed group and the rest showed no significant difference in features. Problems pertaining to the management of Malaysian patients are discussed.
Findings are reviewed of isolated Patent Ductus Arteriosus after infancy as seen in 181 patients studied at the University Hospital, Kuala Lumpur, during the period 1967 to 1975. The ages of patients ranged from nine months to 54 years. Eighty-two patients underwent cardiac catheterization. More than 50% of patients were above ten years of age; the sex ratio was 1 male: 2.93 females. Thirty-two per cent of the patients had significant effort dyspnoea or were in heart failure. The complications noted were elevated pulmonary vascular resistance, Eisenmenger syndrome, bacterial endocarditis and cardiac failure.
Marchiafava-Bignami disease, a rare affliction of alcoholic males, is described in a severely malnourished Malaysian Indian male who took no alcohol. It is the second report of the disease in an Asian and represents one of the few cases which have occurred in non-alcoholics. Besides the pathognomonic demyelination of the central portion of the corpus callosum, there were striking demyelinative plaques in the subcortical white matter. In addition, neuropathological features of Wernicke's disease were found suggesting that severe malnutrition with thiamine deficiency was probably the cause of his demise.
PIP: A great deal of attention is being devoted to the use of nonphysicians to provide such fertility control services as contraception, sterilization, and abortion. Legal obstacles exist, however, which must be overcome before the role of nonphysicians can be expanded. Such obstacles include medical practice statutes, nursing and midwifery legislation, and laws and regulations directly related to such fertility control measures as the provision of contraceptions and the performance of sterilizations. On the other hand, the following 3 main approaches have been used to permit increased participation of nonphysicians: delegation of tasks by physicians, liberal interpretation of existing laws, and authorization. Thus, the important elements in expanding the roles of nonphysicians are 1) authorization; 2) training; 3) qualification; 4) supervision; and 5) opportunities for referrals to physicians. The ultimate role of paramedicals will depend upon the continued simplification of technology, the results of research on the quality of care which they can provide, the attitudes of the medical profession, and the elimination of the legal ambiguities and obstacles which exist.
MeSH terms: Abortion, Induced*; Allied Health Personnel*; Bangladesh; China; Community Health Workers; Contraception*; Delivery of Health Care; Education*; Family Planning Services; Health; Health Personnel; Hong Kong; Indonesia; Japan; Korea; Legislation as Topic*; Malaysia; Midwifery*; Nepal; Nurses*; Philippines; Physicians*; Singapore; Sri Lanka; Sterilization, Reproductive*; Thailand