Central nervous system involvement in melioidosis is rare. We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei. Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion.
A successful excision of a giant cerebral mycotic anuerysm in a young girl with endocarditis is presented. The clinical pictures can be confused with a cerebral abscess. C.T. Scan and angiography are essential in the diagnosis. Rupture of the aneurysm is associated with high mortality and morbidity which can be averted by prompt neurosurgical treatment.
We used Bayes' theorem to calculate the probability of enteric fever in 260 patients presenting with undiagnosed fever, without recourse to blood or stool culture results. These individuals were divided into 110 patients with enteric fever (63 culture positive, 47 culture negative) and 150 patients with other causes of fever. Comparison of the frequencies of occurrence of 19 clinical and laboratory events, said to be helpful in the diagnosis of enteric fever, in the two groups revealed that only 8 events were significantly more frequent in enteric fever. These were: a positive Widal test at a screening dilution of 1:40; a peak temperature greater than = 39 degrees C; previous treatment for the fever; a white blood cell count less than 9 X 10(6)/litre; a polymorphonuclear leucocyte count less than 3.5 X 10(6)/litre; splenomegaly; fever duration greater than 7 d; and hepatomegaly. When the probability of enteric fever was determined prospectively in 110 patients, using only 6 of these discriminating events, the probability of patients with a positive prediction having enteric fever (diagnostic specificity) was 0.80 (95% confidence interval: 0.68 to 0.91) and the probability of those with a negative prediction not having enteric fever (diagnostic sensitivity) was 0.92 (0.85 to 0.99). Using all 19 events did not alter the diagnostic specificity or diagnostic sensitivity. This study shows that a small number of clinical and laboratory features can objectively discriminate enteric fever from other causes of fever in the majority of patients. Calculating the probability of enteric fever can aid in diagnosis, when culturing for salmonella is either unavailable or is negative.
The early Malaysian experience of laparoscopic sterilisation with the Fallope tubal rings, as undertaken at the Obstetrical and Gynaecological Unit of the University Hospital, University of Malaya in Kuala Lumpur, Malaysia is reported in a study of 291 consecutive females that had had the procedure undertaken during the one year period, May 1975 to April 1976. Of the 291 cases, 247 women were sterilised in the "interval" period, 43 after "menstrual regulation" procedure and one after a spontaneous abortion. General anaesthesia was used in all except one case. The salient socio-demographic, contraceptive and reproductive characteristics of study cases are presented and discussed. The technical problems, the early complications and morbidity encountered in this study are presented and discussed in the light of other similar studies, and in relation to sterilisation by laparoscopic tubal electrocoagulation. The overall impression is that laparoscopic sterilisation with the Fallope tubal rings is preferred to that by tubal electrocoagulation, in view of the possible inadvertent serious electrical burns of other structures during the use of the latter procedure.
The aetiology of dry socket continues to be the subject of intense research. Local disturbances of fibrinolytic activity appear to be the most satisfactory explanation for the pathogenesis of this disorder. The factors that are responsible for local changes in fibrinolytic activity are reviewed and evaluated. In the management of this disorder attention should be directed towards the prevention of local changes in fibrinolytic activity.
From January 1980 to December 1982, there were 222 MEDEVAC patients admitted to Mid Hospital, out of whom 206 had their case notes available for this study. The median age of the 206 patients MEDEVAC was 24.5 years and the male to female ratio was 1.2 : 1. The Kenyah, Iban, Punans, Kelabit, Kayan and Murut ethnic groups contributed most of the cases. There was some seasonal variation in the number of MEDEVAC done, the high months being July and December and the low periods in May/June and October/November. Most of the MEDEVAC were requested by ground staff at the remote rural clinics and also district hospitals. The median duration of stay of the patients was 9.7 days. The top five causes for MEDEVAC were: bronchopneumonia; accidental falls; gastroenteritis; peptic ulcers; and appendicitis. 7.8% of the MEDEVAC died in hospital. The management of cases ranged from conservative management to blood transfusions to surgical interventions. Based on the criteria set, 63.6% of the MEDEVAC were considered justified.
A child with massive hepatosplenomegaly was diagnosed on bone marrow biopsy to have Gaucher's disease. The clinical progress in this form of Gaucher's disease is highlighted and the clinical diagnosis correlated with published criteria.
Two cases of late second trimester extrauterine pregnancy are presented--intraabdominal pregnancy in one and an ampullary pregnancy in another. In the former the diagnosis was made only after attempts at induction of labour for fetal death with prostaglandins failed and in the latter only at laparotomy. The diagnostic and surgical problems encountered are discussed.
A review of two third-generation cephalosporins, ceftazidime and cefotaxime, is presented. Ceftazidime, often used as a single agent, has shown greater activity than cefotaxime against Pseudomonas aeruginosa and other Pseudomonas species, Enterobacteriaceae, Acinetobacter sp, and Enterobacter sp. It has been effective as monotherapy in the treatment of peritonitis, gynecologic infections, chronic bronchitis, and infections in patients with leukemia and granulocytopenia, as has cefotaxime when in combination with an aminoglycoside. Cefotaxime has shown good activity against most aerobic gram-negative bacilli and against Staphylococcus. It has been used in respiratory infections, urinary tract infections, and septicemia. In contrast to first-generation and most second-generation cephalosporins, third-generation cephalosporins have proven useful in some types of meningitis. Ceftazidime and cefotaxime successfully penetrate into the cerebrospinal fluid and cures of bacterial meningitis have been reported with both drugs. Both ceftazidime and cefotaxime have been successfully used in children, infants, and neonates, as well as adults. Safety profiles of ceftazidime compare favorably with those of other third-generation cephalosporins.
Myelodysplastic syndromes appear to be a rare group of blood disorders in Malaysia. It usually affects the elderly and some of the cases were reported to evolve into acute leukemia. We describe our experience with five cases, seen and managed by us over a 5-year period. All patients receiving supportive therapy died with one of them definitely known to transform to acute leukemia. The patient who survives till the time of writing received low dose continuous cytosine arabinoside infusion.
Temporary cardiac pacing is an established therapeutic modality in the treatment of heart block and bradyarrythmias due to various causes like drugs and metabolic causes and prior to permanent pacing. Temporary pacing using fluoroscopy is best but the image intensifier is not available to all medical units. The method of temporary pacing at the bedside is described in detail.
Adults who present with sleep walking as a primary complaint is unusual. Two such cases are presented and their association with night terrors and sleep talking discussed. Psychosocial stresses exacerbate sleep walking and acts of violence during the episode can be potentially lethal.
A case of fictitious illness in a young Malaysian Indian male is reported and its relation to the more usual presentation of factitious disorders is discussed. Pathogenesis of this condition and its management are also suggested. Factitious disorders present not uncommonly in this country and it is important for the general duty medical officer and primary care physician to be familiar with this condition.
A 35 year old Chinese female with classical presentation of paroxysmal nocturnal haemoglobinuria is reported. The various aspects of these conditions are discussed.