Eccrine cylindroma is a benign tumour arising from sweat glands in the skin. It favours the face, forehead and scalp involving the turban area and hence is called a turban tumour. Amongst a variety of tumours originating from adnexal skin structures, which may appear in the ear canal, eccrine cylindroma forms a very rare entity. We present such a case and discuss its pathological and clinical features.
This is a retrospective observational study of outcome of 11 cases of vaginal hysterectomy for undescended and enlarged uterus carried in University Hospital, Kuala Lumpur. The cases included relative contraindications such as 14 weeks size fibroids, severe obesity, previous Caesarean section and nulliparity. All the eight patients agreeable for prophylactic bilateral salpingoophorectomy had their ovaries removed. Operative time ranged from 1 hr 20 min to 2 hr 15 min. All patients were sent home within 48 hours of the operation. The excellent outcome of our initial experience highlights the known advantages of vaginal hysterectomy for undescended and enlarged uterus.
In the world of medical literature, little has been reported about the fears of patients undergoing bronchoscopy. The aim of this study was to identify the common fears of patients undergoing fibreoptic bronchoscopy and to determine whether any factors might contribute to reducing these fears. One hundred and four consecutive patients undergoing bronchoscopy were interviewed. Sixty one patients expressed fear about the procedure, as follows: afraid of pain (33); afraid of breathing difficulties (11); afraid of oropharyngeal irritation (5); afraid of the bronchoscopy findings (2); afraid of sedation, cross-infection and nasal lignocaine spray, respectively (3); and unable to be specific (7). There was no difference between the "no fear" and "fearful" groups in ethnicity, source of referral, education, previous endoscopy, doctors' explanation and the patients' understanding of the procedure and its indication. "Fearful" patients were significantly younger (t=2.082, p=0.037) and female (chi2=4.180, p=0.038). Doctors were more likely to explain the indication for bronchoscopy than how it would be performed (chi2=6.403; p=0.011), and patients were more likely to understand why they needed a bronchoscopy than how it would be performed (chi2=21.505; p<0.001). Fear preceding bronchoscopy is independent of patients' demographic features except for age and gender. Doctors tend to explain "why" but not "how" the procedure is performed. Provision of detailed information about sensations that are likely to be experienced in bronchoscopy could be used to allay some of these common fears.
A registry of patients with end stage renal disease was started from 1st January 1990 at Hospital Sultanah Aminah, Johor Baru. There were 126 patients in 1990 and 129 in 1991. The peak age was 31 to 60 years old; males outnumbered females 1.5:1. Forty-three to fifty-six percent presented with small kidneys. Seventeen to twenty percent of patients had diabetes mellitus. In 1991, the racial distribution of patients was Malay: 50.4%, Chinese: 39.5%, Indian: 7.8% and others: 2.3%. The incidence of end stage renal disease in Johor Baru district was 79 per million per year in 1990 and 86 per million in 1991.
Sixty-one free flaps performed in 59 patients from April 1983 to April 1995 were analysed. Various factors that might have affected the outcome of the surgery were studied. These included the patient's age, history of smoking, pre-existing medical problems such as hypertension and diabetes mellitus, the type of free flaps, flap infection, use of postoperative anticoagulation, postoperative anaemia and re-exploration. The infection rate was 16.4% and this had a strong correlation with the free flap failure in our study population. Postoperative anaemia could adversely affect the tissue oxygenation of the free flap and delay the re-exploration due to the high anaesthetic risk. Dextran was routinely used for postoperative anticoagulation. There were also rescue attempts using heparin infusion when needed. The overall failure rate was 13.1%. Besides good anaesthetic support, a well-prepared protocol is necessary both for the preoperative planning of free flap surgery as well as salvaging a failure.
We are reporting a case of autologous blood transfusion in a patient who underwent a repair of her aortic aneurysm. Even though the operation was major and carried a high mortality, no homologous blood was used at all.
Cytohormonal evaluation was done on the vaginal smears of 480 normal, asymptomatic, post-menopausal women whose ages ranged from 36 to 74 years. About 50% showed atrophic smears consistent with total oestrogen lack. 41% had mild to moderately proliferative smears compatible with sub-optimal oestrogen stimulus. 9% showed a highly proliferative pattern typical of unopposed oestrogen effect and in this group two women had atypical endometrial cells in their smears, which subsequently were found to come from an atypical endometrial hyperplasia and an endometrial adenocarcinoma-in-situ. The clinical relevance of cytohormonal studies in post-menopausal women is briefly discussed.
Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.
We report a case of total occlusion of the left main coronary artery (LMCA) in a patient with chronic, stable angina. Total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually also disease in other parts of the coronary arterial tree.
Data on blood cholinesterase levels in the Malaysian population is lacking. The spectrophotometric method of Ellman was used to determine the red cell, plasma and whole blood cholinesterase (ChE) levels in 407 Malaysian blood donors. The mean+1SD for plasma ChE in females (n = 48) was 2.37 + 0.70 umol/min/ml and 2.76 + 0.75 umol/min/ml in males (n = 359). The mean plasma ChE in males was higher than in females (p < 0.001). The mean+1SD for red cell ChE in females was 9.01 + 1.20 umol/min/ml whereas in males it was 7.69 +1.30 umol/min/ml (the mean red cell ChE in females was higher than in males, p < 0.0001). The mean+1SD for whole blood ChE for females was 4.31+ 0.58 umol/min/ml and for males it was 4.95 + 0.71 umol/min/ml. The mean whole blood ChE in males was higher than in females (p < 0.0001). Sex influenced the plasma, red cell and whole blood ChE. In males the plasma ChE was affected by the race factor. The mean+1SD plasma ChE for the Malay, Chinese and Indian were 2.92 + 0.80, 2.73 + 0.71 and 2.61+ 0.73 respectively (p < 0.002). The age factor in males affected the red cell ChE with 7.88 + 1.32 in the (30-69) age group and 7.47 + 1.23 in the (15-29) age group (p < 0.005). The whole blood ChE in females was affected by blood groups. The mean+1SD whole blood ChE for blood groups A,B and O were 4.19 + 0.42, 3.93 + 0.46 and 4.49 + 0.62 respectively (p < 0.03). The significant difference is between the ChE of group B and O, but the ChE of group A could not be determined to be different from group B or O. These results serve as guidelines for our local population in the evaluation of cholinesterase levels with regard to pesticide poisoning, liver biosynthetic capacity and unusual sensitivity to succinylcholine.
Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeons faced with this problem. Two such cases and their outcome are presented. The first case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. The second case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. Both patients died for reasons unrelated to the pneumoperitoneum. The passage of air from the chest cavity into the abdominal cavity was along the great vessels in the first case and through the diaphragm in the second. A compilation of other aetiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest visceral perforation, an abdominal tap or lavage should be attempted. If negative, continued observation is advised.
Adrenal tumours are either functioning or non-functioning. Non-functioning adrenal tumours are generally asymptomatic and usually of enormous proportions at the time of presentation. A case is presented here of a patient with a huge right adrenal haemangioma which was successfully treated surgically. This unusual tumour was 25 cm in diameter, was well encapsulated and weighed 4 kg. The literature pertaining to this interesting case is reviewed.
Primary non-Hodgkin's lymphoma of the brain is rare. Majority of the lesions are intraaxial, multicentric and involve the leptomeninges. We report a case of malignant primary non-Hodgkin's lymphoma arising from the cranial vault. Computed tomography of the brain showed an extraaxial lesion in the right parietal region mimicking a meningioma.
A study has been conducted on 198 employees of a steel-mill industry. These participants were examined for mucosal lesions in the oral cavity and including the commissures and vermillion borders of the lips. The prevalences of 16 types of lesions are reported.
Raised intraocular pressure (lOP) is generally held responsible for causing visual loss in chronic simple glaucoma. It is therefore desirable that a safe level of lOP be maintained all the time. Elevation of lOP with change of body position has been suggested as one of the factors which result in tissue damage in low tension as well as in primary wide open angle glaucoma. Postural behaviour of lOP was therefore studied in 58 normal and 30 glaucomatous Malaysian eyes. Clinical significance and possible pathogenesis of abnormal postural response of lOP has been discussed. More application of this simple procedure is advocated.