Hidrotic ectodermaldysplasia was found, to our knowledge, for the first time in a Chinese family in Malaysia, and it affected 15 members in five generations. The disease, which is transmitted as a non-sex-linked autosomal dominant trait, presumably originated from southern China. All 15 members had the typical nail, hair, and skin lesions, and we observed three different types of nail defects. Scalp alopeica was more extensive in the female members while keratoderma of the palms and soles was more notable in the male members. The nail and skin lesions also became severer with age. Except for the infectious eczematoid dermatitis present in the propositus, none had other skin or systemic disorders. All were relatively healthy and had normal life expectancies;
Data for the ABO blood groups and for handclasping, arm folding, handedness, ear lobe types and camptodactyly are presented for 104 Malay and 57 Chinese males in the city of Alor Star, Kedah, Malaysia. The two groups exhibit marked differences in the frequencies of most of these attributes.
One-hundred-and-four patients unth. hand eczema were studied. The female to male ratio was 1.9:1 and peak incidence was in young adulthood. In females, housewives constituted the biggest group while in males, mechanics/engineers was the biggest group. 30% of the patients had contact sensitivity on patch testing to a standard series. Balsams, medicaments, rubber ingredients, nickel and formaldehyde were the common allergens. The contact sensitivity was considered relevant in 65% of cases.
Matched MeSH terms: Hand Dermatoses/etiology*; Hand Dermatoses/epidemiology
Continuous brachial plexus block in six patients undergoing reimplantation of severed fingers or hand is described. The technique involved placement of a catheter within the neurovascular sheath enclosing the brachial plexus. This enabled us to give the local anaesthetic as required to last the whole duration of surgery.
Many operations have been described for the correction of claw hands following involvement in leprosy, from Sir Harold Stiles (1922) of Edinburgh, through Bunnell, Brand and many others in India and USA. Some of these procedures are classified "static" and attempt mainly to correct hyper-extension at the metacarpo-phalangeal joint, while the "dynamic" procedures employ a variety of tendon graft operations to restore the function of the paralysed lumbrical muscles. This study is an analysis of the four-tailed tendon graft operation of Paul Brand, carried out in the National Leprosy Con. trol Centre, Sungei Buloh, Selangor, during the period 1965·175, by a host of surgeons, mainly by Dr M.K. Bhojwani, MRCP, FRCSEd, the Director of the Centre at that time. The analysis carried out during November. December 1976, was made on 36 hands in 33 patients; it revealed an average improvement in the metacarpo. Phalangeal joint flexion of nearly 90% and in the proximal interphalangeal joint extension in nearly 80%, and an improvement in the grafted lumbrical voluntary motor tone of nearly 70%.
Matched MeSH terms: Hand Deformities, Acquired/etiology; Hand Deformities, Acquired/surgery*
When referring to amputation, the immediate association tends to be amputation related to trauma. There is little doubt that injury is by far the commonest cause of amputation, but one must not forget that babies might also be born with amputations of the upper limb. This latter group of amelia composes the various types of congenital amputations.
The plasma cholinesterase baseline levels in Malaysian workers are within the guidelines used. There is a need to carry out close monitoring of workers handling organophosphate s even in a well-run, modern factory where there are no hazards in the plant operation. Abnormal results are mainly because many of our workers are unaware of the health hazards and do not follow orders properly, ie personal hygiene, such as washing of hands before eating, etc. The use of temporary workers should be discouraged because of poor compliance with rules and difficulty in follow up. Product stewardship and education of farmers, sprayers and end users are of paramount importance. Finally there is a great need for educaiton of everyone from factory workers, farmers, sprayers to the general public.
Actinic prurigo is a chronic familial photodermatitis found predominantly among the Amerindians. It has been reported from North and South America, Britain and Japan. We report a case of actinic prurigo seen in Singapore. A 20-year-old Malay female presented with a persistent pruriginous eruption in the sun-exposed parts and on her abdomen. She also had lower lip cheilitis and thinning of the outer eyebrows, features often seen in actinic prurigo. The minimal erythema dose to ultraviolet A (UVA) and UVB were persistently lowered. We propose that this condition be called actinic prurigo, tropical (South-East Asian) variant.
Publication year=1992-1993
A 19-year-old Malay male succumbed to a septicaemia caused by Chromobacterium violaceum 11 days after onset of illness. The organism is a common soil saprophyte and may be considered as contaminant on culture. It is essential to recognise its clinical significance in purulent processes so that appropriate therapy can be instituted. We report the first fatal case of Chromobacterium violaceum infection in the University Hospital, Kuala Lumpur.
The present study was conducted to evaluate the role of ingestion through hand and mouth contamination in the absorption of lead in 25 lead-acid battery workers. Levels of personal exposure to airborne lead ranged from 0.004 to 2.58 mg/m3 [geometric mean 0.098, with 25% of samples exceeding threshold limit values (ACGIH) of 0.15 mg/m3]; the mean (SD) blood lead level was 48.9 (10.8) micrograms/dl. Mean hand lead contents increased 33-fold from preshift levels on Monday mornings (33.5 micrograms/500 ml) to midshift levels on Thursday afternoons (1121 micrograms/500 ml). Mouth lead contents increased 16-fold from 0.021 micrograms/50 ml on Mondays to 0.345 micrograms/50 ml on Thursdays. The typical Malay racial habit of feeding with bare hands and fingers without utensils (closely associated with mouth and hand lead levels on Mondays) explained the bulk of the variance in blood lead levels (40%), with mouth lead on Thursdays (closely associated with poor personal hygiene) explaining a further 10%. Air lead was not a significant explanatory variable. The implementation of a programme of reinforcing hand-washing and mouth-rinsing practices resulted in a reduction of the blood lead level by 11.5% 6 months later. These results indicate that parenteral intake from hand and mouth contamination is an important cause of lead absorption in lead-exposed workers.
A closed enteral delivery system consisting of a cardboard tetrapack containing the sterile ready-to-use liquid feed and an independent sterile administration set, has been devised. We found bacterial contamination within 24 hours in this system in patients on ventilatory support in intensive care. This emphasises the need for meticulous care in handling enteral feeding systems to prevent environmental contamination.
A significant number of hand infections were found to occur in college students, a group not associated with manual labour. Diabetics did not have a significant delay in recognising the symptoms but have a significant longer period of hospitalisation. The right hand was predominantly involved especially the thumb, index finger and the thenar region. Staphylococcus aureus was the commonest infecting organism.
Six hands from five patients were seen with full-thickness burns following a ritual practice between June 1993 and June 1994. Three hands were treated with excision and medium-thickness split-skin grafts, one patient was treated with a medium-thickness split skin graft taken from the instep of the foot. The first patient with bilateral burns of the palms refused surgery and returned 3 months later with contractures of the palms. The results of the treated hands are presented.