In a 10 year period 1971-1980, the records of 944 individual women with benign breast lumps and 228 with primary carcinomata are reviewed. This study describes the age, ethnic distribution of benign and malignant breast tumours in women in Peninsular Malaysia and compares the pattern with Western experience. There are important variations in the incidence pattern between the different races in Peninsular Malaysia and between them and women in Britain and the United States.
MeSH terms: Adult; Age Factors; Breast Neoplasms/epidemiology*; Ethnic Groups; Female; Humans; Malaysia
Left atrial myxoma almost always arises in the inter-atrial septum. A case is described where it arose from the posterior wall of the left atrium. Clinical presentation was suggestive of mitral stenosis and sub-acute bacterial endocarditis and diagnosis was arrived at necropsy.
There is evidence to show that paraquat poisoning is alarmingly common in Malaysia. This paper reviews 30 cases of paraquat poisoning seen at the General Hospital, Kuala Lumpur from 1978 to 1979 inclusive. Preventive measures and management are discussed. It is felt that tighter legislation to control its use in agriculture should be implemented now.
Eighteen infants clinically suspected to be intolerant of cow's milk were placed on a milk-free formula and six to eight weeks later were orally challenged with cow's milk. Following challenge three groups were recognised. Group A: Four infants tolerated oral feeds ofcow's milk and lacked mucosal abnormality or clinical symptoms. Group B: Seven infants had mucosal deterioration but lacked clinical symptoms and tolerated cow's milk. Group C: Seven infants had mucosal abnormality, developed clinical symptoms and were intolerant of cow's milk. The intestinal transudation of IgA was increased in Group A and unchanged in Group Band C : the IgM levels in the duodenal juice was increased in Group A and B but unchanged in Group C : the IgG levels in the juice were increased in all Groups following challenge. It appears that increased transmission of IgA and IgM or IgM alone in the duodenal juice is associated with lack of development of clinical symptoms. Symptoms are present in infants in whom the IgA and IgM levels in duodenal juice remained unchanged after challenge. It is suggested that patients responding to cow's millt challenge with intestinal production of IgA and IgM (or IgM alone) are able to counter balance the deleterious mechanisms leading to clinical cow's milk intolerance whereas those who, for some unknown reason, do not mount a secretory immune response become ill.
A random sample of 102 hypertensives out of a total of 347 in the Malaysian Armed Forces were studied with regard to patient education, knowledge of hypertension and therapy compliance. It was found that for 53 percent, patient education was unsatisfactory and as a result 67 percent had inadequate knowledge of hypertension. Adherance to therapy - drug intake, weight reduction and cessation of smoking - was poor (more than 59 percent, 96 percent and 70 percent failure respectively). There was no significant difference between asymptomatically and symptomatically detected hypertensives.
MeSH terms: Adult; Humans; Hypertension/psychology; Hypertension/therapy*; Malaysia; Male; Middle Aged; Military Medicine*; Patient Compliance*; Patient Education as Topic
Women in an urban, Malay population reported menstrual period lengths that tended to coincide with the lengths of the calendar months in which the periods began. This pattern may be related to the calendar-month pay periods for the population.
In a 3 year period 73 cases of perforated peptic ulcers were treated by simple closure. The overall mortality of 3.77 percent is acceptable when compared with other reports. There was a marked male preponderance (11 males: female 1). Biopsy results confirmed the operatiue findings that perforations were seven times more common in gastric peptic ulcers than duodenal ones. The disease affected young adults, the middle aged and elderly, the peak incidence occurring between the fifth and seventh decades oflife. Simple closure was an effective surgical procedure for our group of patients.
The prevalence of goitre was investigated in a sample from six longhouses and five primary schools located at varying degrees of remoteness along the Tinjar river, Sarawak. Together with this, a survey was made on the type of salt used by the households. The main ethnic groups in these communities were the Kenyah/Kayan and the Iban. The overall prevalence of palpable goitre detected from the age group 5-14 years were 71.7 percent and 77.0 percent for males and females respectively and 77.7 percent for females aged 15 years and above. The prevalence for both Iban and Kenyah/Kayan of either sex and for all age groups varied from 63.4 percent to 80.4 percent. The prevalence at each location did not differ significantly. On questioning 126 households, only 9 (7.1 percent) used iodized salt whilst 74 (58.7 percent) households used only uniodized coarse salt and 7 (5.6 percent) used only uniodized fine salt. The remaining 36 (28.6 percent) households used both fine and coarse uniodized salt. Undoubtedly at this point in time legislation on "table" salt iodization must be interpreted to mean not only the iodization of fine table salt, but in the case of the rural longhouse communities as are found in the Tinjar area, the iodization of coarse salt as well.
MeSH terms: Adolescent; Age Factors; Child; Child, Preschool; Female; Goiter, Endemic/epidemiology*; Humans; Malaysia; Male; Sex Factors
A case of traumatic chylothorax is presented with its typical clinical presentation. Failure of conservative measures led to a transthoracic ligation of the thoracic duct, with good result.
An analysis of 86 patients sterilized laparoscopically with Hulka clips is presented. We find that the method is simple, acceptable and has minimal complication. The failure rate is similar to that reported by others. However, this method could be done under local anaesthesia thus shortening the hospital stay for the patients. This method has the advantage of safety and prospects for reversal when desired.
Over the six-veer periodfrom. 1976 to 1981, there were 241 neonates referred to the U.K.M. Paediatric Surgical Unit, General Hospital, Kuala Lumpur for alimentary tract obstruction and 207 were operated on. The three commonest conditions were anorectal anomalies (91 cases), Hirschsprung's disease (31 cases) and oesophageal atresia (30 cases). Overall operatioe mortality was 28.0 percent. This was high when preoperative complications lihe gut perforation (88.9 percent) or pneumonia (61.9 percent) and associated severe anomalies (90.9 percent) or chromosomal abnormalities (66.7 percent) were present. Emphasis is placed on the establishment of early diagnosis and the significance of the green vomit and maternal hydramnios is highlighted, The need is felt for more specialised nurses and the creation of a separate neonatal ICU in this hospital.
M-mode echocardiograms of six patients with a diagnosis of Ebstein's anomaly and confirmed by cardiac catheterization were reviewed. All the patients (5 females and 1 male) were Caucasians with their ages ranging from one day to twenty-six years. The tricuspid valve was easily located in all the echo cardiographic studies. There was a 45 to 100 msec delay in tricuspid valve closure as compared to the mitral valve closure, in all patients. The amplitude of the anterior tricuspid valve was found to be greater than the amplitude of the anterior mitral valve in all but one case. Paradoxical septal movement type A was observed in four cases. None of the cases had a right ventricular end diastolic diameter that was larger than the left ventricular end diastolic diameter. The study found that it was extremely difficult to specifically diagnose Ebstein's anomaly with M-mode echocardiography alone, as each case has not been able to meet with all the criteria for diagnosis, described by various investigators.
Twenty Malaysian patients with unresectable primary liver cell cancer were prospectively studied at the General Hospital, Kuala Lampur, and were compared for clinical features with an equal number each of African and American patients being studied by the Eastern Cooperative Oncology Group. The patients received intravenous 5-FU and oral MeCCNU which was used for the first time in an Asian country. Most of the Malaysian patients were Chinese, belonged to younger age groups, and presented with massive hepatomegaly, jaundice, and fever. Toxicity to MeCCNU invariably occurred in the form of leukopenia or thrombocytopenia, but none life threatening. Partial response was seen in 20% of Malaysians as compared to 16% in Americans and none in Africans. Malaysians achieved a median survival of 16 weeks compared to 28 weeks in Americans and only eight weeks in Africans. Malaysian Chinese patients were all HBc Ab + ve. Other factors which may have played an etiologic role in the induction of primary liver cancer included alcohol, Chinese herbal medicines, aflatoxin and habitual use of medicated rubbing oils.