The public especially in West Malaysia are becoming more aware of their rights and litigations are on the increase. Fortunately in East Malaysia there are fewer cases. The legal aspects of anaesthesia practice are very much on the lines of British system. Here the cause for compensation or legal action depends on the proof of negligence. Currently in West Malaysia all anaesthetics are being given by medical practitioners. In East Malaysia the anaesthetics are being given mainly by Medical Assistant's who have been trained for about six months to give anaesthesia in all government hospitals. There are guidelines on minimum standard of safety for patients undergoing general anaesthesia, though this is not as elaborate as those in Western countries.
The effect of an antiprostaglandin, piroxicam, in preventing surgically induced miosis is studied. Patients undergoing extracapsular cataract surgery were randomly divided into the piroxicam and placebo groups. Intra-operative measurements of the pupillary diameters were performed. The stages of procedure at which they were measured were at the beginning of operation (Stage 1), after anterior capsulotomy (Stage 2), after lens nucleus delivery (Stage 3) and at the end of irrigation and aspiration (Stage 4). It is noted in this Study that the pupillary diameters were larger at stages 2,3 and 4 in the piroxicam group. The increase in the mean pupillary areas of the piroxicam group were statistically significant for Stages 3 and 4.
A total of 38 cases of fireworks related injuries from Hospital USM over a 5-year period from 1986 to 1990 during Hari Raya festival were analysed. The majority (68.5%) of the patients were teenagers, between 10 to 19 years of age. All the cases were Malays and most of the accidents occurred before the Hari Raya Idilfitri festive seasons. Fourteen cases were caused by self-made fireworks and another 16 cases were due to modified fire-works. Twenty-four cases suffered permanent disabilities mostly finger amputations. Such injuries could be prevented by law enforcement coupled with public health education to modify social behaviour especially when the ban against the use of fireworks is lifted on religious grounds.
A case-control study was carried out to determine the child-minding practices and their relationships with nutritional status of children between 6 and 12 months old. Sixty-five percent of the mothers go to the farm and 25 percent of, them bring their children with them. Only 42.8 percent of the children were looked after by their mothers. The odds of being malnourished were greater among children who were not looked after by their mothers. It is suggested that nutrition education be given in the village so that the other child-minders can benefit from it.
In the University Hospital, Kuala Lumpur, from 1984 to 1990, 184 patients with acute conjunctivitis were examined for chlamydial infection by direct immunofluorescence. Overall, 52 (28.3%) were found to be positive for chlamydial antigen. There was no significant difference in the detection rate between men and women and among the 3 major ethnic groups. The detection rate was highest among sexually active adults. Epidemiological and clinical features suggest that most of the chlamydial ocular infections seen were inclusion conjunctivitis and not classical trachoma.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
The effectiveness of sodium citrate as a prophylaxis against acid aspiration syndrome was studied in 3 groups of obstetric patients. Group I was the control group which consisted of 20 patients in established labour who were not likely to require caesarean section. No antacid had been given to these patients. Group II consisted of 20 patients who underwent elective caesarean section, while Group III consisted of another 20 patients who underwent emergency caesarean section. Group II and III were given 30ml of 0.3M sodium citrate as soon as they arrived in the operation theatre. The gastric content was aspirated after the induction of anaesthesia and at the end of surgery just before extubation. The volume was measured and a sample sent for pH analysis. Sodium citrate was found to increase the gastric pH significantly in both Group II and III patients when compared with Group I patients who underwent emergency caesarean section. We conclude that 30ml of 0.3M sodium citrate is effective in increasing gastric pH though it tends to be associated with an increase in gastric volume.
Two series of Blood Pressure (BP) measurements were carried out to assess the variability in BP following repeated measurements in normotensive individuals. In one series, measurement of BP on three occasions three and seven days apart revealed a significant drop in BP in unaccustomed subjects ('untrained'). In a second series assessing the significance of time-interval between measurements or the number of measurements, it was found that a significant fall in BP occurred over the first four days in 'untrained' individuals, whose blood pressure was measured repeatedly for five consecutive days. A significant positive correlation was evident between the falls in systolic and diastolic pressures and the pressure at first screening. Assessment of the anxiety status revealed a significantly lower state anxiety in 'trained' subjects. It therefore appears that (a) BP in normotensive individuals previously unaccustomed to BP measurements, drops significantly with repeated measurements, (b) the number of measurements seem more important than the time-interval between measurements, (c) the largest falls occur in individuals with high initial pressures and (d) the fall upon repeated measurements may be due to reduced anxiety as familiarity with the procedure makes the subjects comparatively relaxed and less state anxious.
Torsion of the flliJopian tube is an uncommon condition but cases have been reported fairly often since the first case published by Bland Sutton in 1980. The following case report is presented because we have not found any report in the literature where torsion of the fallopian tube was asymptomatic and only discovered incidentally during Caesarean Section.
Endometriosis and its complications are not uncommon in Malaysian women. Two cases of ureteric obstruction due to endometriosis are reported and the literature on ureteric obstruction and endometriosis reviewed. It is emphasized that the possibility of ureteric obstruction must be suspected when there is extensive endometriotic disease or if the patient presents with loin pain or pain on one side of the abdomen. Ultrasound scan of the kidneys and, if necessary, an intravenous pyelogram will have to be done on the slightest suspicion. Patients with endometriosis will have to be followed up until the menopause or even later if they are on hormone replacement therapy.
Aneurysms of the sinus of Valsalva are uncommon disorders and are usually congenital in origin. When these aneurysms rupture into an intracardiac chamber, they may be silent initially but later give rise to progressive heart failure due to left or right shunting and aortic regurgitation. The mortality and morbidity in untreated cases is high. We report 13 patients with ruptured aneurysms of the sinus of Valsalva who underwent surgical repair. There were seven males and six females with a mean age of 24.5 years. Three patients were asymptomatic and five were in congestive cardiac failure. The majority of patients (61.5%) had insidious onset of symptoms, only 2 cases presenting acutely. The connection was between the right aortic sinus and the right ventricle in 11 cases and the non coronary sinus and the right ventricle in 2 cases. Associated cardiac anomalies included a ventricular septal defect (8 patients) and aortic regurgitation (6 patients). There was 1 post operative death and 1 patient required re-operation three months later for a recurrence of the fistula. All 6 patients with aortic regurgitation required aortic valve replacement. All patients remained well and asymptomatic during follow up ranging from 2 to 19 years.
A thirty six week gestation male baby weighing three kilogram was born to a twenty five year old mother by spontaneous vaginal delivery. At four hours of life, the baby developed respiratory distress with cyanosis and was admitted to the neonatal intensive care unit. There was clinical and radiological evidence of bilateral pleural effusion. Thoracentesis revealed a transudate. Repeated thoracentesis was necessary to relieve the respiratory distress. Subsequently, multi resistant Klebsiella aerogenes was isolated from the blood. The baby expired due to gram negative sepsis.
A 61-year old lady presented clinically in unstable angina with ST-segment depression typical of myocardial ischemia. However, coronary arteries were completely normal at angiography. Exercise testing reproduced symptoms and ST-segment depression. A diagnosis of Syndrome X was made, an uncommon disorder of myocardial ischemia with normal coronary anatomy and excellent prognosis.
We report here a rare case of bilateral pure gonadoblastoma which accounts for only 0.2% of all ovarian tumours seen at Universiti Kebangsaan Malaysia from 1980 to 1987. This tumour occurred in an 18 year old Chinese "female" who presented with primary amenorrhoea. Examination showed a phenotypic female with poorly developed external gentalia. Exploratory laparotomy revealed a hypoplastic uterus, rudimentary fallopian tubes and streak gonads. Histological examination of the gonads showed a mixed tumour comprising large germ cells and smaller sex cord derivatives arranged in characteristic nests or islands containing hyaline material.
Three clinical cases of fungal corneal ulcers are described to highlight the course, ocular morbidity and principles of treatment. A brief discussion of the diagnosis and management of ulcerative keratomycosis is presented.
Three main types of PVC solvent polymeric membrane ion-selective electrodes for chloroquine are described. They are based on three ion-pairing agents namely dipicrylamine (DPA), tetraphenylborate (TPB) or tetrakis(4-chlorophenyl)borate (TCPB) with either dioctylphenyl phosphonate (DOPP) or trioctyl phosphate (TOP) solvent mediator. All electrodes exhibit Nernstian responses, fast dynamic response times and a wide useful pH range. The best all-round electrode is based on TPB and TOP plasticizing solvent mediators with a limit of detection of 7.1 x 10(-6)M and was utilized for the assay of chloroquine in tablets. Direct potentiometric determinations with either the analyte addition method or the normal calibration method gave results comparable to the official method.
Southeast Asian ovalocytosis (SAO) is a hereditary condition that is widespread in parts of Southeast Asia. The ovalocytic erythrocytes are rigid and resistant to invasion by various malarial parasites. We have previously found that the underlying defect in SAO involves band 3 protein, the major transmembrane protein, which has abnormal structure and function. We now report two linked mutations in the erythrocyte band 3 gene in SAO: (i) a deletion of codons 400-408 and (ii) a substitution, A----G, in the first base of codon 56 leading to substitution of Lys-56 by Glu-56. The first defect leads to a deletion of nine amino acids in the boundary of cytoplasmic and membrane domains of band 3. This defect has been detected in all 30 ovalocytic subjects from Malaysia, the Philippines, and two unrelated coastal regions of Papua New Guinea, whereas it was absent in all 30 controls from Southeast Asia and 20 subjects of different ethnic origin from the United States. The Lys-56----Glu substitution has likewise been found in all SAO subjects. However, it has also been detected in 5 of the 50 control subjects, suggesting that it represents a linked polymorphism. We conclude that the deletion of codons 400-408 in the band 3 gene constitutes the underlying molecular defect in SAO.