A 35 year old Chinese female with classical presentation of paroxysmal nocturnal haemoglobinuria is reported. The various aspects of these conditions are discussed.
Tuberculosis of the thyroid gland is a rare condition. A case of tuberculosis of the thyroid gland presenting as a solitary thyroid nodule is presented. Management is operative intervention and anti-tuberculous chemotherapy. The final diagnosis is made after histopathological confirmation of the typical appearances.
A case of fictitious illness in a young Malaysian Indian male is reported and its relation to the more usual presentation of factitious disorders is discussed. Pathogenesis of this condition and its management are also suggested. Factitious disorders present not uncommonly in this country and it is important for the general duty medical officer and primary care physician to be familiar with this condition.
MeSH terms: Child; Factitious Disorders/psychology*; Humans; Male
Adults who present with sleep walking as a primary complaint is unusual. Two such cases are presented and their association with night terrors and sleep talking discussed. Psychosocial stresses exacerbate sleep walking and acts of violence during the episode can be potentially lethal.
A 50-year-old male had an acute jejunogastric intussusception complicating a Bilroth 11 gastrectomy done 20 years previously for peptic ulcer. Preoperatively, the diagnosis was suspected from the plain abdominal radiograph which was subsequently confirmed by barium meal. The patient had an uneventful recovery following resection of the intussuscepted segment and an end-to-end anastomosis. Although rare, the condition is serious and should be recognised promptly and treated surgically. The diagnosis should always be considered in a patient who has had a previous gastrojejunostomy presented with a sudden onset of epigastric pain, bloody vomitus and epigastric mass.
Acute dacroadenitis is a rare condition. This case illustrates the acute onset, typical pain and tenderness in the upper outer eye of an enlarged lacrimal gland with purulent discharge. Good response to antibiotics is usual.
One-hundred-and-thirty-one female stroke patients were identified in a retrospective analysis of female medical admissions to the Penang General Hospital during 1983. The hospital medical admission rate of women with stroke was significantly higher amongst the Chinese than the Malays [p < 0.001) or the Indians (p < 0.001). A higher proportion of Indians than Chinese or Malays presented within 24 hours of the onset of illness. The case fatality rate at discharge was 34% when patients taken home moribund were included as fatal cases. Such cases where patients were taken home at their own risk (AOR) were common among the Malays and the Chinese but did not occur amongst the Indians.
Study site: female medical wards, Penang General Hospital
The Cardiothoracic Department, General Hospital, Kuala Lumpur which was set up in April 1982, deals with a wide range of cardiac disease, general thoracic and also vascular cases. A total of 2,450 operations were performed from April 1982 to February 1987, and 79.3% of these were for cardiac cases (open and closed heart). This paper reports a review of the 1,110 consecutive open heart operations performed by the Department during the stated period.
Temporary cardiac pacing is an established therapeutic modality in the treatment of heart block and bradyarrythmias due to various causes like drugs and metabolic causes and prior to permanent pacing. Temporary pacing using fluoroscopy is best but the image intensifier is not available to all medical units. The method of temporary pacing at the bedside is described in detail.
MeSH terms: Cardiac Pacing, Artificial/methods*; Humans; Time Factors
A patient with a cervical aortic arch associated with a coarctation of the aortic arch and a Tetralogy of Fallot presented to the General Hospital, Kuala Lumpur.
The clinical course of 68 patients who had temporary transvenous pacing for complete heart block in acute myocardial infarction is reviewed. There were 59 male and 9 female patients, of which 32 were Indians, 20 were Malays and 16 Chinese. 48 patients had inferior infarct, 16 patients developed anterior infarct and 4 patients presented with combined anteriorinferior infarction. The overall mortality for complete heart block in this study is 44%. The mortality pattern is 25% for inferior infarct; 87% for anterior infarct and 100% for combined anterior and inferior infarct.
Eleven consecutive cases of simple transposition of great arteries were palliated by balloon atrial septostomy, The arterial saturation was improved and the gradient across the atrial septum was reduced or abolished. Improvement in the clinical status was achieved in all the patients. There was no mortality and morbidity was mild. A description of the technique as well as a brief review of the anatomy and haemodynamics of complete transposition of great arteries are the aims of this paper.
MeSH terms: Catheterization*; Female; Heart Atria; Cardiac Catheterization; Heart Septum*; Humans; Infant; Male; Ostomy/methods; Transposition of Great Vessels/therapy*
Twenty two Asian eyes suffering from open angle glaucoma were treated by argon laser trabeculoplasty and were followed for an average of eleven months. 77.27% of eyes were controlled with ALT alone. The pressure lowering effect of argon laser trabeculoplasty in this series was found to be consistent. Argon laser trabeculoplasty may become the preferred method of treating open angle glaucoma in the Asian population.
The effects of breast-feeding on infant health and mortality, particularly in the developing nations, are a matter of controversy and importance. The Malaysian Family Life Survey (MFLS) of over 1200 women has recently been the source of a great deal of valuable information on the influence of breast-feeding and interacting social variables on the incidence of infant mortality. Accuracy of reporting of breast-feeding duration is a key issue in the validity of studies of breast-feeding and infant mortality. This paper presents an illustrative analysis of the quality of breast-feeding data from the Malaysian Family Life Survey, using logit model schedules. Lesthaeghe and Page derived a logit model schedule of breast-feeding, summarizing empirical experience. This family of model breast-feeding duration curves is similar to the logit model life tables developed by Brass, and was intended for similar applications. To verify the MFLS retrospective breast-feeding reports, the observed median duration and variability were calculated for ethnic group/cohort subsets, and expected duration distribution curves were generated from the model using these observed parameter values. The expected curve generated from the model fit the observed curve of breast-feeding discontinuation extremely closely. Thus it is unlikely that any significant distortion of the pattern of discontinuation of breast-feeding occurred in data collection. Extensions of this method of data quality checking to other duration distributions are suggested.
MeSH terms: Breast Feeding*; Data Collection/standards*; Female; Humans; Malaysia; Retrospective Studies; Time Factors
MeSH terms: Age Factors*; Asia; Asia, Southeastern; Behavior; Birth Rate*; Contraception Behavior; Culture; Demography*; Developing Countries; Economics*; Educational Status*; Ethnic Groups*; Evaluation Studies as Topic*; Family Planning Services; Fertility; Financial Management; Government Programs*; Health Planning*; Health Planning Guidelines*; Health Services Administration*; Health Services Research*; Infant Mortality; Malaysia; Mortality; Organization and Administration; Population*; Population Characteristics*; Population Dynamics*; Research; Research Design*; Sexual Behavior; Social Change*; Social Class; Social Planning*; Socioeconomic Factors*; Statistics as Topic*; Health Care Rationing*; Program Evaluation*; Multivariate Analysis*; Efficiency, Organizational*; Knowledge