We present here a technique of fracture stabilization using the Tightrope procedure in a patient with a widely displaced Neer type IIB distal clavicle fracture. The Tightrope system, typically used for stabilization of acromioclavicular joint dislocation, has not been widely described for distal clavicle fractures. The patient achieved satisfactory results after surgery; we feel that this technique is appealing as it is simple, reproducible and avoids the complications associated with extensive metalwork. This technique may also appeal to the arthroscopic surgeon.
Traumatic intractable epistaxis following fractures of the facial and base of skull rarely may be life-threatening. Common sites of injury are the internal carotid and maxillary artery. When conventional methods of arresting haemorrhage fail, the choices are then an open arterial ligation or superselective embolisation. This paper presents a patient with life-threatening epistaxis from a Le Fort type II fracture. Angiography revealed a maxillary artery injury in which superselective embolisation was performed and the haemorrhage was successfully arrested. A literature review of this technique is discussed, including its advantages and the relationship of the internal maxillary artery to facial fractures.
Sensory analysis of lipstick product by trained panellists started with recruiting female panels who are lipstick users, in good health condition and willing to be a part of sensory members. This group of people was further scrutinized with duo-trio method using commercial lipstick samples that are commonly used among them. About 40% of the 15 panels recruited were unable to differentiate the lipstick samples they usually use better than chance. The balance of nine panels that were corrected at least with 65% across all trials in panels screening process was formed a working group to develop sensory languages as a means of describing product similarities and differences and a scoring system. Five sessions with each session took about 90 min were carried out using 10 types of lipsticks with different waxes mixture ratio in the formulation together with six commercial lipsticks that are the most common to the panels. First session was focus on listing out the panels' perception towards the characteristic of the lipstick samples after normal application on their lips. Second session was focus on the refining and categorizing the responses gathered from the first session and translated into sensory attributes with its definition. Third session was focus on the scoring system. Fourth and fifth sessions were repetition of the third session to ensure consistency. In a collective effort of the panels, sensory attributes developed for lipstick were Spreadability, Off flavour, Hardness, Smoothness, Moist, Not messy, Glossy and Greasy. Analysis of variance was able to provide ample evidence on gauging the panel performance. A proper panels selecting and training was able to produce a reliable and sensitive trained panel for evaluating the product based on the procedures being trained.
We describe a 5 1/2 year old boy who was diagnosed with mild autosomal recessive osteopetrosis based on the presence of bony sclerosis, extramedullary haematopoeisis, leukoerythroblastosis and visual impairment who had an allogeneic bone marrow transplant from a matched sibling donor. Conditioning regime was busulphan 16 mg/kg and cyclophosphamide 200 mg/kg. Apart from transient hypercalcaemia, there were no major post transplant complications. Four years post transplant, the extramedullary haematopoeisis has resolved completely with normal blood counts. Apart from a fracture after a trivial fall two months after transplant, he has not suffered any fracture related limb deformities.
Mental foramen is an opening of the mental canal onto the lateral surface of the mandible. In this pilot radiographical study, in Malay population the effects of ageing towards the location and visibility of the mental foramen were determined. Most of the mental foramina were found to be located inferior to the apex of the second premolar. Non-visibility of the foramen was greatly increased in patients aged 50 years and above (Pearson Chi-square; p = 0.00). This finding may provide a guide to dental surgeries in Malay patients of different age groups.
This article describes the completed suicide patterns which occurred in the Timur Laut district of Penang Island, Malaysia. In a prospective cohort study over the three years period (2007-2009) there were 138 cases of suicide deaths. The number of suicide deaths for the year 2007, 2008 and 2009 were 45, 41 and 52 deaths, respectively. Majority of the suicide deaths were by jumping from height (47.1%), followed by hanging (34.1%) and by drowning (10.9%). The male victims outnumbered females in a 3 : 1 ratio.
Foetus-in-fetu is a rare condition in which a calcified mass is in the abdomen of its host, a newborn or an infant. We report a case of a newborn in whom abdominal radiograph and ultrasonography revealed a mass in which the contents favour a foetus-in-fetu. Diagnosis was confirmed by macroscopic examination that showed a soft tissue mass resembling a foetus, attached to the membranous sac. It was covered entirely with intact skin. There were two malformed lower limbs with a rudimentary digit and one malformed upper limb.
We present a rare case of a multifocal sclerosing haemangioma of the lung in a 49-year-old lady. A left pneumonectomy with complete excision of the tumour seems to be the curative treatment. The recent literature on this unusual presentation is reviewed.
This paper describes the preliminary work required to understand cultural differences in palliative care in the United Kingdom and three countries in the Asia-Pacific region, in preparation for a cross-country study. The study is intended to address cultural understandings of palliative care, the role of the family in end of life care, what constitutes good care and the ethical issues in each country. Suggestions are then made to shape the scope of the study and to be considered as outcomes to improve care of the dying in these countries. It is anticipated that the method used to achieve consensus on cross-country palliative care issues will be both qualitative and quantitative. Identifying key priorities in the delivery and quality measures of palliative care will involve participants in focus groups, a Delphi survey and in the development of clinical indicators towards creating standards of palliative care common to the Asian Pacific region.
The renal artery is known to exhibit variations in its number and position. The present study was performed on 50 cadaveric kidneys to observe the topographical anatomy of the accessory renal arteries (ARA) entering the upper or lower poles of the kidney. Out of 50 kidney cadaveric specimens (irrespective of sex) studied, 2 kidneys (4%) showed the presence of ARA. The presence of ARA was observed on the left and right kidneys, respectively. In one left kidney, we observed in addition to the usual renal artery, an ARA near the lower pole of the kidney which divided into anterior and posterior branches. Another right kidney specimen exhibited the presence of single and double ARA at the upper and the lower poles, respectively. The presence of ARA, both at the upper and lower poles is a rare entity. No medical history of the cadavers was available to corroborate the clinical findings. Additional renal vessels may signify a developmental defect. Anatomical knowledge of the variations in the renal vascular supply may be important for abdominal imaging studies and surgical operations involving renal transplantations. The present study discusses in detail the anatomical features and clinical implications of ARA located at both the upper and lower poles of the kidney (Fig. 2, Ref. 15). Full Text (Free, PDF) www.bmj.sk.
Embryonal rhabdomyosarcoma is an exceedingly rare tumor in adult. We report an embryonal rhabdomyosarcoma of the ethmoid in a 59-year-old Iban lady who presented with proptosis and complete ptosis of her left eye for two months. Imaging investigations showed left ethmoidal and left orbital soft tissue mass with extradura and dura involvement. The patient was planned for chemotherapy. Unfortunately, in such an advanced disease, she succumbed before treatment.
We studied two similar cases of severe subglottic stenosis secondary to trauma with different treatment modalities. One had laryngotracheal reconstruction with cartilage augmentation and the other had laryngotracheal resection anastomosis. We wish to compare the two popular choices of surgery for laryngotracheal stenosis from two cases with similar nature and severity thus highlighting the complexity of managing severe subglottic stenosis in adult.
Breast cancer is one of the most important diseases in females worldwide. According to the Malaysian Oncological Society, about 4% of women who are 40 years old and above are involved have breast cancer. Masses and microcalcifications are two important signs of breast cancer diagnosis on mammography. Enhancement techniques, i.e. histogram equalization, histogram stretching and median filters, were used to provide better visualization for radiologists in order to help early detection of breast abnormalities. In this research 60 digital mammogram images which includes 20 normal and 40 confirmed diagnosed cancerous cases were selected and manipulated using the mentioned techniques. The original and manipulated images were scored by three expert radiologists. Results showed that the selected methods have a positive significant effect on image quality.
Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of "heatiness" or "negative energies". Coining is associated with serious complications, and has been confused with child abuse by physicians unfamiliar to Asian cultures. Despite the availability of more simple and effective treatment for fever, coining is still widely practiced among Asians.
Adolescent smoking is an emerging health concern in the developing countries. A cross-sectional study is conducted to determine the prevalence and smoking behaviour of adolescents in Sarawak. The prevalence of smoking is 32.8% with mean age of initiation at 12.8±1.9 years. Most (67.2%) adolescents are experimental smokers and the majority (67.9%) did not smoke on a daily basis. Branded cigarettes are preferred (83.1%) and the cigarettes are obtained either from friends (49.1%) or self purchased (43.6%). Students prefer to smoke at their friend's house (31.0%) or at school (25.3%). Smoking prevalence among adolescents in Sarawak is high and begins early. Early intervention on smoking prevention and risk awareness is perhaps more effective if initiated before the age of 12 years.
BACKGROUND: Methadone is a synthetic opiate mu receptor agonist that is widely used to substitute for illicit opiates in the management of opiate dependence. It helps prevent opiate users from injecting and sharing needles which are vehicles for the spread of HIV and other blood borne viruses. This study has the objective of determining the utility of daily methadone dose to predict retention rates and re-injecting behaviour among opiate dependents.
METHODS: Subjects comprised opiate dependent individuals who met study criteria. They took methadone based on the Malaysian guidelines and were monitored according to the study protocols. At six months, data was collected for analyses. The sensitivity and specificity daily methadone doses to predict retention rates and re-injecting behaviour were evaluated.
RESULTS: Sixty-four patients volunteered to participate but only 35 (54.69%) remained active and 29 (45.31%) were inactive at 6 months of treatment. Higher doses were significantly correlated with retention rate (p < 0.0001) and re-injecting behaviour (p < 0.001). Of those retained, 80.0% were on 80 mg or more methadone per day doses with 20.0% on receiving 40 mg -79 mg.
CONCLUSIONS: We concluded that a daily dose of at least 40 mg was required to retain patients in treatment and to prevent re-injecting behaviour. A dose of at least 80 mg per day was associated with best results.