Temporary obturator is necessary for maxillectomy procedures to minimise functional disabilities of speech and the swallowing of food and fluid following surgery.l.2 It also provides a base to hold surgical packing and/ or tissue conditioners in place. This packing helps to restore function and counter act contraction during healing of the ,tissues at the operated site. Dental clinicians are often faced with the problem of surgical staffs requesting an obturator for their patients at short notice.This article describes a fast technique of constructing an immediate surgical obturator.
The preliminary investigation was carried out to assess the severity of malocclusion between two centres, the dental schools in Leeds, United Kingdom and Kuala Lumpur, Malaysia. A total of 99 study models were analysed using the Index ofOrthodontic Treatment Need (lOIN). Thestudy models were ofpatients aged 8to 15years, equally distributed between male and female patients taken from the undergraduate and staff clinics. Forty nine and fifty study models were analysed at the Leeds Dental School and FacultyofDentistry,University ofMalaya,respectively.Fromthisobservation, it appeared that the sample of patients treated at the Faculty of Dentistry, Kuala Lumpur presented approximately 25%higher with casesin the severe end of the malocclusion based on the dental health component and almost 70%more with the aesthetic component. Factors contributing to this finding are discussed.
This paper represents a study of35casesofodontogenic keratocyst (OKC) diagnosed in a Malaysian population. The clinical, radiological and histopathological features, treatment modalities and recurrence of this lesion were analysed. There was a higher prevalence rate among Malaysian Chinese (51.42 percent), while the Malays and Indians accounted for22.86 percent and 25.72 percent respectively. The male to female ratio was 16 : 19.Age at presentation ranged from nine to 71 year,with about 70percent occurring between ages ten to 39 years. A total of40cysts were analysed. Of these, 67.5 percent occurred in the mandible and 32.5 percent in the maxilla. About 88percent of OKC presented as unilocular radiolucencies and 42.0 percent were associated with unerupted or impacted teeth. Histologically, the parakeratinized OKC was the predominant variant found (75.8 percent). The majority of caseswere treated by enucleation (85 percent), and a recurrence rate of20percent was recorded.
The root canal walls of twenty -five deciduous molar teeth with exposed and necrotic pulps were examined using thescanning electronmicroscope. Immediately after extraction, all teeth were fixed in Kamosky's solution. The coronal portion of the tooth was sectioned at about 2mm above the enamel cemental junction.The mesial and distal roots were separat~d and either split in the mesio-distal or bucco-lingual direction. All specimens were prepared for SEM. Obsevations showed that all roots were infected with organisms consisting of cocciand short rods. Some of the coccihad penetrated the dentine layer. However, the distribution of organisms is. not uniform throughout thecanals. Bacterialinvasion ismostinthecoronal region and reduces towards the apical region: Accompanying bacterial invasion is root canal walls deterioration. The odontoblastic processes are the first to deteriorate followed by the predentine layer.
A differential phenomenological study of acute and chronic schizophrenia is scanty. Thought disorder was assessed in 22 acute and 23 chronic schizophrenics. The scale for the assessment of thought, language and communication was used. Poverty of speech was significantly more frequent in acute schizophrenia. Positive formal thought disorder was unusually found to be severer in chronic schizophrenia. No other significant difference was found. From the perspective of thought disorder, acute and chronic forms of schizophrenia seem to be in a continuum with minimal difference.
We determined the 240-nucleotide sequences of the E/NS1 gene junction of four dengue-2 viruses by the primer extension dideoxy chain termination method. These viruses were isolated from dengue patients with different clinical severities in Nakhon Phanom, Northeastern Thailand in 1993. The results were compared with the 52 published dengue-2 sequences of the same gene region. Sequence divergence of four new isolates varied from 4.17% to 5.42% compared with dengue-2 prototype New Guinea C strain whereas it varied from 5.42% to 6.67% and from 6.67% to 7.09% when compared with Jamaica 1409 strain and PR159/S1 strain, respectively. All nucleotide substitutions were found at the 3rd position of the codons which were silent mutations. All 56 isolates studied were classified into five genotypic groups by constructing the dendrogram. The results indicated that four new isolates from Northeastern Thailand belong to genotype II of dengue virus serotype 2, and were most closely related to prototype New Guinea C strain. We also observed the variation in nucleotide and amino acid sequences among clusters of isolates (Thailand-1980, Malaysia-1989 and Thailand-1993) which were obtained from the dengue patients with different clinical severities. The significance of these genetic differences have been discussed in terms of the possible correlation between genetic variability and virulence.
Standard renal clearance techniques were used to compare the effects of intravenous infusions of L-arginine, D-lysine and glycine on urinary calcium excretion in the rat. A significant calciuric response was evident following the infusion of all three amino acids in all the animals. The maximal effect was evident in rats receiving L-arginine. The mechanism for the increased urinary calcium excretion in rats infused with L-arginine and D-lysine appeared more due to a decreased fractional reabsorption of this cation as no significant changes in the glomerular filtration rate (GFR) were evident in these two groups. The calciuria in rats receiving glycine appears due to increased filtered load secondary to the increased GFR, suggesting that the mechanism for calciuria evident following protein ingestion or amino acid infusion may vary and may be dependent upon the amino acid ingested or infused.
We performed a hospital-based study to examine a hypothesis that indoor air pollution was associated with acute asthma in young children living in Kuala Lumpur City. A total of 158 children aged 1 month to 5 years hospitalized for the first time for asthma were recruited as cases. Controls were 201 children of the same age group who were hospitalized for causes other than a respiratory illness. Information was obtained from mothers using a standardized questionnaire. Univariate analysis identified two indoor pollution variables as significant factors. Sharing a bedroom with an adult smoker and exposure to mosquito coil smoke at least three nights in a week were both associated with increased risk for asthma. Logistic regression analysis confirmed that sharing a bedroom with an adult smoker (OR = 1.91, 95% CI 1.13, 3.21) and exposure to mosquito coil smoke (OR = 1.73, 95% CI 1.02, 2.93) were independent risk factors. Other factors independently associated with acute asthma were previous history of allergy, history of asthma in first-degree relatives, low birth weight, and the presence of a coughing sibling. There was no association between asthma and exposure to kerosene stove, wood stove, aerosol mosquito repellent, type of housing, or crowding. We conclude that indoor air pollution is an avoidable factor in the increasing morbidity due to asthma in children in a tropical environment.
The effects of ovariectomy and hormone replacement in control and carcinogen treated female rats were investigated by measuring whole blood and liver glutathione (WGSH, HGSH), glutathione S-transferase (GST), glutathione peroxidase (GPx), and glutathione reductase (GRx) and histological evaluation. Hepatocarcinogenesis was induced by diethylnitrosamine and 2-acetylaminofluorene. In control rats not receiving carcinogen, ovariectomy significantly increased the GST and GRx activities. Replacement with either estrogen or progesterone reduced the GST activities to below intact female values whereas replacement of both hormones together brought the GST activities to that of intact females. GRx activities were brought to intact female values by replacement with estrogen or progesterone, either singly or in combination. Neither ovariectomy nor sex hormone/s replacement influenced the levels of WGSH, HGSH and GPx activities. Carcinogen administration to intact rats increased all the parameters measured. Ovariectomized rats treated with carcinogen showed lower GPx and GRx activities at 2 mths. However, replacement with either progesterone or combined estrogen and progesterone increased GPx and GRx activities to original values. On the other hand GST and GPx activities in ovariectomized rats which had carcinogen treatment were lower than intact rats after 5 mths. Replacement with hormones either singly or both brought GST and GPx activities up to intact rat levels receiving carcinogen. The levels of WGSH, HGSH and GRx activities (5 mths) in carcinogen treated rats were not influenced by ovariectomy and/or hormone/s replacement. The results from this study suggested that ovariectomy reduced the severity of hepatocarcinogenesis which was restored by sex hormone/s replacement.
We report the first double-blind, placebo-controlled study that assesses the efficacy and safety of omeprazole 20 mg daily in the maintenance treatment of duodenal ulcer. For the healing phase, 128 patients with endoscopically proven active duodenal ulcer and a history of three or more relapses during the 2 years prior to the study were treated until healing with omeprazole 40 mg daily for 2 and up to 8 weeks. One hundred and twenty-three patients whose ulcers were healed were randomized to receive omeprazole 20 mg daily (n = 60) or placebo (n = 63) for 12 months as maintenance treatment. Patients were interviewed at 3, 6, 9 and 12 months, and endoscopy was performed at 3, 6 and 12 months and whenever symptoms recurred. The healing rates of the 124 patients completing the healing phase were 84, 98 and 100% at 2, 4 and 8 weeks, respectively. During the maintenance phase, eight and four patients discontinued treatment from the omeprazole and placebo groups, respectively. The proportion of patients in remission in the omeprazole group and placebo group after 12 months were 94 and 9% respectively (life table estimates, P < 0.0001). No significant clinical or laboratory changes were observed in patients on therapy with omeprazole. Patients with a history of frequent relapses thus continued to have a very high relapse rate without prophylactic treatment. Omeprazole 20 mg daily was effective and safe in maintaining such patients in remission.
A new sanguinicolid blood fluke, Parasanguinicola vastispina, is described from sea bass Lates calcarifer cultured in Malaysia. It is distinguished by its massive armature and widely spaced genital pores, the female pore being pre-ovarian. P. vastispina inhabits the branchial arteries, dorsal aorta, mesenteric venules and renal artery of its host. No pathological effect was observed in infected fish.
This study was conducted to explore the outcome of psychotherapy in ethnic Malays with strong religious and cultural background. The patients were divided into two groups. The study and control groups consisted of 32 depressed patient each. In the study group brief psychotherapy of 15-20 sessions was attempted with the addition of a religious perspective, while in the control group the religious perspective was omitted. Patients in the study group showed more rapid improvement in the initial 3 months of the study period than those in the control group, but at the end of the 6 months the difference became nonsignificant.
The response of human skin to "stress relaxation" tests at low loads in vitro was investigated. A number of behaviours, other than those already well established and documented, were observed. The significant behaviours are pure recovery and relaxation-recovery. Other behaviours observed are temporary stress recovery during the relaxation process, and momentary sudden non-linear drop in stress value followed by a second relaxation. The pure recovery and relaxation-recovery responses are repeatable. The latter represents the transitional response between the well-known behaviour of stress relaxation and the behaviour of stress recovery.
Leaves of two plant species eaten by Macaca fascicularis in Bukit Timah Nature Reserve, Singapore, were collected and colour-tested. Leaves matching those eaten by M. fascicularis were examined by energy-dispersive X-ray micro-analysis. The leaves of Streblus elongatus (Moraceae) and Gluta wallichii (Anacardiaceae), together forming 19.6% of the leaf diet of the macaques, contained silica. In G. wallichii, this in the base of hairs that project from the underside of the leaf, whereas S. elongatus leaves have short sharp siliceous trichomes which are densely packed on the undersurface of leaf veins. We predict from an indentation analysis that chewing on the latter species could cause dental microwear at low occlusal forces. The leaves are reportedly common in the diet of three other primate species in peninsular Malaysia and the finding could have general significance for studies of dental wear.
Multiple-choice questions (MCQ) are widely used to evaluate students in the health sciences, including anatomy. Unusual responses in 90 simple MCQ examinations have been identified and classified as to cause, including a number of illustrated examples. About one-quarter of these errors were attributable to the teacher and could have been avoided by a critical analysis of the questions before use. The increasing use of sophisticated formats of the MCQ in medical education indicates that teachers need to analyze their questions more carefully before and after actual tests to minimize errors.
We examined human tissues infected by Burkholderia (Pseudomonas) pseudomallei which is endemic in Malaysia to study the types of inflammation invoked, and to look for histopathological clues to its diagnosis. The lesions which varied from acute to chronic granulomatous inflammation were not tissue-specific. In five autopsy cases, the inflammation was usually a focal or diffuse, acute necrotising inflammation with varying numbers of neutrophils, macrophages, lymphocytes and 'giant cells'. The 'giant cells' probably represent giant macrophages with phagocytosed leukocytes. There were numerous gram-negative, non-acid-fast, intra- and extracellular bacilli, occurring either singly or in chains. Intracellular bacteria within macrophages and 'giant cells' were so numerous as to resemble globi. This feature has not been previously reported and may be a useful diagnostic clue in melioidosis. In 14 surgical cases biopsies showed acute inflammatory lesions that appeared no different from acute inflammation due to other causes. In many biopsies, however, the inflammation was either an acute-on-chronic inflammation with a focal granulomatous component, or was purely granulomatous in character. Bacilli were difficult to demonstrate in surgical biopsies even with the gram strain.
The hydroxide ion-catalyzed hydrolysis of securinine involves the ring opening of the lactone moiety. The rate of hydrolysis is insensitive to the ionic strength. The observed pseudo-first-order rate constants reveal a decrease of approximately 4-fold due to the increase in the MeCN content from 4 to 50% (v/v) in mixed aqueous solvent. The temperature dependence of the rate of hydrolysis follows the Eyring equation, which yields delta H* and delta S* as 11.0 kcal mol-1 and -34.5 cal deg-1 mol-1, respectively. The hydroxyl carboxylate product of the alkaline hydrolysis of securinine is shown to undergo cyclization in acidic medium to yield securinine. The observed pseudo-first-order rate constants for cyclization increase linearly with an increase in [H+]. The change in the content of MeCN from 3.8 to 47.2% (v/v) in mixed aqueous solvents does not show an effect on the rate of the cyclization reaction. The most plausible mechanisms for alkaline hydrolysis and acid cyclization reactions are also discussed.
MeSH terms: Alkaloids/chemistry*; Central Nervous System Stimulants/chemistry*; Azepines*; Cyclization; Half-Life; Heterocyclic Compounds, Bridged-Ring; Heterocyclic Compounds with 4 or More Rings; Hydrolysis; Kinetics; Lactones*; Piperidines*; Sodium Hydroxide; Spectrophotometry, Ultraviolet; Temperature
Isotricha jalaludinii n. sp. found in the rumen of lesser mouse deer, Tragulus javanicus, in Malaysia was described and illustrated. This new species is characterized by the location and direction of the vestibulum, shape of the macronucleus, and absence of a dent at the vestibular opening. The presence of single peculiar isotrichid species in the rumen of mouse deer, which is recognized as one of the most primitive ruminants, suggests that the isotrichid ciliates similar to I. jalaludinii and Isotricha intestinalis were established at a fairly early period during the evolution of ruminants.