A cross-sectional study was conducted to examine the use of prescription drugs among elderly patients (> or = 60 years old) admitted to medical wards in Hospital Kuala Lumpur, Malaysia. A total of 204 elderly (101 men and 103 women) were interviewed. Eighty two percent of the elderly were taking at least one prescription drug, with 39.2% taking > or = 5 drugs. Prescription drugs commonly used were antihypertensives (54.4%), antidiabetics (40.2%), drugs used in haemostasis (36.8%), nitrates (33.3%) and diuretics (32.4%). Factors associated with increased use of prescription drugs were: more number of chronic diseases, self-rated health status as poor, low Barthel score, and Chinese women.
The present study deals with the analysis of body composition components of 86 randomly selected patients with confirmed pulmonary tuberculosis aged 16- 70 years collected from the District Tuberculosis Centre and Hospital, Amritsar. An adequate number of controls were also taken for comparison. The findings of the present study showed highly significant differences (p < or = 0.001) in all the twelve kinanthropometric variables except height. When the data was further analyzed between sputum negative and sputum positive patients with pulmonary tuberculosis, highly significant differences (p < or = 0.001) were found only in total body fat and statistically significant differences (p < or = 0.05) were observed in weight, chest circumference in normal position, abdominal circumference, right calf and buttock circumferences. It may be concluded that TB patients were more malnourished than normal people. Thus, special nutritional care should be taken to the TB patients to give them a better quality of life.
An Indian man from Malaysia presented with contracture of his hands. He is 55 years of age and has a history of chronic alcohol consumption. Examination revealed bilateral thickened structure at the palms.
Records of 46 patients who were treated for primary hyperparathyroidism at King Khalid University Hospital, Riyadh Saudi Arabia from 1st July 2000 to 30th June 2006 were reviewed. Mean age at diagnosis was 44 years (range 13-70 years) and average duration of symptoms was 39 months (1 month to 11 years). There were 35 females and 11 males with a ratio of 3.2:1. Bone pains were the major symptoms at presentation in 45.7% followed by no symptom in 23.9%, renal stones in 15.2%, polyuria in 6.5%, while 4.3% each presented with depression, and constipation. Males had significantly more severe disease with higher serum calcium, higher urinary calcium excretion, and higher serum creatinine. Ninety six percent of patients had successful surgery and 4% (two patients) each had recurrence and hungry bone syndrome. It is concluded that PHPT in Saudi Arabia continues to be a symptomatic disorder with skeletal and renal manifestations occurring at a younger age and males having more severe disease. Further prospective studies are needed to verify our findings.
This study attempted to estimate the lifelong magnetic field (MF) exposures of a particular group of welders. Exposure was quantified via measurements, observations and interviews. It was found that these welders face a vast range of lifelong MF exposures depending on the welding processes and duration of the welding tasks performed. This may explain the inconsistency in the results of studies of MF exposures on human health. The mere assessing of the MF exposure levels through spot measurements does not give an overall picture of the total amount of exposure received by the welders as some of these workers performed the welding task throughout the day, whereas others performed this as a part of their job. The exposure to various chemicals in the fume may complicate the interpretation of the elevated health risk among the welders.
The incidence of wound related complication following total knee arthroplasty is as high as 10%-20%. To perform total knee arthroplasty in a knee with extensive scarring around the knee can be a challenging task. We report a case of 55-year-old diabetic woman, who had total knee arthroplasty, performed two years after she had recovered from necrotizing fasciitis around the right knee. Understanding the vascular anatomy around the knee is of paramount importance in the planning of skin incision to ensure fewer wound related complications.
We report an unusual co-existence of Burkholderia pseudomallei and acid fast bacilli in a young Malay gentleman with liver abscess. He was treated with antibiotics and surgical drainage. This phenomenon has not been reported in previous literature and the dilemma of its management is discussed.
Knowledge of variations of veins of head and neck in relation to external jugular, anterior jugular, internal jugular, and facial veins is important to surgeons doing head and neck surgery as well as to radiologists doing catheterization and to clinicians in general. In the current case, multiple variations in the veins of the left side of neck are reported. The anterior division of retromandibular vein was absent. The facial vein continued as anterior jugular vein. The internal jugular vein was duplicated above the level of hyoid bone. There was a large communicating vein between the anterior jugular vein and anterior division of internal jugular vein. Lingual vein drained into the communicating vein. Jugular venous arch was abnormally large, doubled, and highly placed. The veins of the right side were normal.
Robotic surgery was started in the Department of Urology, Hospital Kuala Lumpur, in April 2004. We present our experience in developing the program and report the results of our first 50 cases of robotic radical prostatectomy. A three-arm da Vinci robotic system was installed in our hospital in March 2004. Prior to installation, the surgeons underwent training at various centers in the United States and Paris. The operating theatre was renovated to house the system. Subsequently, the initial few cases were done with the help of proctors. Data were prospectively collected on all patients who underwent robot-assisted radical prostatectomy for localized carcinoma of the prostate. Fifty patients underwent robot assisted radical prostatectomy from March 2004 to June 2005. Their ages ranged from 52 to 75 years, (average age 60.2 years). PSA levels ranged from 2.5 to 35 ng/ml (mean 10.6 ng/ml). Prostate volume ranged from 18 to 130 cc (average 32.4 cc). Average operating time for the first 20 cases was 4 h and for the next 30 cases was 2.5 h. Patients were discharged 1-3 days post-operatively. Catheters were removed on the fifth day following a cystogram. The positive margin rate as defined by the presence of cancer cells at the inked margin was 30%. Twenty-one patients had T1c disease and one had T1b on clinical staging. Of these, two were apical margin positive. Twenty-six patients had T2 disease and eight of them were apical margin positive. Two patients had T3 disease, one of whom was apical margin positive. Five patients (10%) had PSA recurrence. Five patients had a poorly differentiated carcinoma and the rest had Gleason 6 or 7. Eighty percent of the patients were continent on follow-up at 3 months. Of those who were potent before the surgery, 50% were potent at 3-6 months. The robotic surgery program was successfully implemented at our center on the lines of a structured program, developed at Vattikuti Urology Institute (VUI). We succeeded in creating a team and safely implemented the robotic program in our system. Adequate funding and extensive training followed by a short term proctoring are essential for this implementation.
Nocturia is a common symptom associated with benign prostatic hyperplasia which can persist even after effective treatment of BPH. Other causes may be responsible. We investigated a group of patients who were treated for BPH and continue to have nocturia. Our study has found a high prevalence (85.4%) of nocturnal polyuria in this group of patients. It has important clinical implication since the condition can be effectively treated with oral desmopressin. Empirical treatment without a routine frequency volume chart may be appropriate due to its high prevalence.
Pneumoperitoneum is almost always pathognomonic of a perforated abdominal viscus requiring urgent surgical intervention. Spontaneous or non-surgical pneumoperitoneum is a rare clinical condition arising secondary to abdominal, thoracic, gynaecologic or idiopathic causes. In addition to good clinical judgement, an important component in the management process is to rule out other causes of pneumoperitoneum by performing appropriate investigations. We describe a 60-year-old man who presented with clinical features of pseudo-obstruction, following an injury to his back which was compounded by hypokalaemia. Roentgenography revealed massive pneumoperitoneum and colonic distension. As there were no overt clinical features of peritonitis, the patient was managed conservatively with parenteral nutrition and close observation. A water-soluble contrast enema and computed tomography of the abdomen were of no help in identifying the cause of his pneumoperitoneum but were helpful in eliminating the presence of hollow viscus perforation or an obvious inflammatory focus. The aetiology of pneumoperitoneum in our patient was most likely due to dissection of air through the distended colonic wall, secondary to large bowel pseudo-obstruction. The diagnosis of spontaneous or non-surgical pneumoperitoneum is one of exclusion and we stress the importance of relying on clinical parameters when managing such patients conservatively.
Inverted papilloma is the most common benign tumor of nose and paranasal sinuses arising from lateral nasal wall and middle meatus. Histologically these tumors are composed of epithelial nests that are inverted, exophytic and cylindrical. Here we describe a clinical case of nasal cylindrical cell papilloma, which was treated by endoscopic excision.
A 62-year-old man presented with a 2-month history of right occipito-parietal headache and worsening ipsilateral ptosis. CT scan and cerebral angiography revealed a large fusiform aneurysm of the P2 segment of the right posterior cerebral artery (PCA). The aneurysm was successfully trapped and subsequently excised via sub temporal approach leaving no additional neurological deficits to our patient.
Variations in the arterial pattern of upper limb are of colossal importance to the surgeons as they are liable to iatrogenic injuries. During routine dissection for undergraduate medical students, an anomaly of brachial artery was discovered. The brachial artery terminated at higher level into ulnar and radial artery. The common interosseus artery took origin arising from radial artery. The ulnar artery did not give any branches in the forearm. Both radial and ulnar artery displayed a superficial course in the forearm. The anatomical knowledge of these variations may be of great help for the clinicians in planning and conducting flap harvesting during reconstructive surgeries and in arteriography.
A review of routine histopathological samples and autopsies examined at the Department of Pathology, University of Malaya revealed 15 cases of amyloidosis of the lung. Two were localized depositions limited to the lung while in the remainder, lung involvement was part of the picture of systemic amyloidosis. Both cases of localized amyloidosis presented with symptomatic lung/bronchial masses and a clinical diagnosis of tumour. Histology revealed "amyloidomas" associated with heavy plasma cell and lymphocytic infiltration and the presence of multinucleated giant cells. In both cases, the amyloid deposits were immunopositive for lambda light chains and negative for kappa chains and AA protein. One was a known systemic lupus erythematosus patient with polyclonal hypergammaglobulinaemia. The other patient was found to have plasma cell dyscrasia with monoclonal IgG lambda gammopathy. Both patients did not develop systemic amyloidosis. In contrast, lung involvement in systemic AA amyloidosis was not obvious clinically or macroscopically but was histologically evident in 75% of cases subjected to autopsy. Amyloid was detected mainly in the walls of arterioles and small vessels, and along the alveolar septa. It was less frequently detected in the pleura, along the basement membrane of the bronchial epithelium and around bronchial glands. In one case of systemic AL amyloidosis associated with multiple myeloma, an "amyloidoma" occurred in the subpleural region reminiscent of localized amyloidosis. These cases pose questions on (1) whether localized "tumour-like" amyloidosis is a forme fruste of systemic AL amyloidosis and (2) the differing pattern of tissue deposition of different chemical types of amyloid fibrils, with the suggestion that light chain amyloid has a greater tendency to nodular deposition than AA amyloid.
The anaesthetic experience in three patients undergoing thoracoscopic oesophagectomy is discussed. The indications for surgery and the premorbid states are outlined. The necessity for one-lung ventilation, with its attendant cardiopulmonary effects, the difficulty of patient access and the assessment of blood loss were the main problems encountered. Pulmonary morbidity was high in the post-operative period despite the avoidance of thoracotomy. Two patients developed persistent vocal cord paralysis. In conclusion, the role of thoracoscopic oesophagectomy needs further evaluation.
To study the process of establishment, and evaluate the outcome of participation, in a self-help support group for people with chronic nonmalignant pain, members of a newly-established, consumer-led group participated in two interviews 5 months apart and a researcher observed group meetings. Participants reported significant benefits from participating in the group. They had a significant increase in functional ability and activity, and reported decreased recourse to health professionals, particularly family physicians. This study indicates that pain support groups can play a valuable role for people in pain, assisting with support and rehabilitation, and meeting needs that health professionals are often not appropriate or able to provide.
Acute suppurative thyroiditis in a 62 year old lady with enteric fever is reported. Plain radiography of the neck showed a distinct localised abscess cavity with air fluid level. A rare causative agent Salmonella typhi was isolated. Needle aspiration and antibiotics resulted in complete recovery.