Between January 1982 and December 1989, 12 patients with 13 acute extradural haematomas as a result of injury involving the venous sinuses were treated by the first author. The CT scan appearances in 6 cases were remarkable in that there were large bubbles of low density in the hyperdense haematomas and liquid blood was found during the operation. The possible underlying pathophysiological changes that gave rise to this appearance are discussed. The CT scan appearance and the proximity of the clot to the venous sinuses should alert the neurosurgeon to the high probabilities of venous sinus tear such that proper treatment can be offered.
A prospective study to correlate clinical digoxin toxicity with serum digoxin levels was carried out in 67 patients of whom 24 were clinically toxic and 43 were asymptomatic. The patients were clinically diagnosed to be toxic based on typical cardiac arrhythmias (n = 11) or non-cardiac symptoms (n = 13). Blood samples were collected at least six hours after the last digoxin dose and the sera assayed for digoxin using a radioimmunoassay method. The mean serum digoxin level in the toxic group (x1 = 2.09 +/- 1.28 ng/ml) was significantly higher than in the non-toxic group (x2 = 1.20 +/- 0.75 ng/ml), p less than 0.01. All the non-toxic patients had serum digoxin levels below 3 ng/ml. However, there was a considerable overlap of serum digoxin levels between the two groups of patients. Serum level cannot be the sole criterion in diagnosing digoxin toxicity. Nevertheless, raised serum digoxin levels especially above 3 ng/ml, in the presence of suggestive clinical features is strongly suggestive of toxicity.
Although the patterns of dental disease is gradually changing, caries and periodontal disease still account for the most important reason for extractions in most countries. However their relative contributions towards overall tooth mortality figures varies. The aim of this study is to investigate the types of teeth usually associated with extractions due to caries or periodontal disease and its relation to the age at which the tooth was lost. The highest proportion of extractions due to caries occurred between 21 to 30 years of age while that for periodontal disease occurred between 41 to 50 years. For caries, the greatest proportion of extractions involved the posterior teeth. The most frequently extracted teeth due to caries are the molars, in particular the first permanent molar. However, for periodontal disease a slightly greater proportion of anterior teeth were lost than the posteriors. This trend is more marked in the lower jaw than the upper. Overall, extractions related to caries tend to increase posteriorly, while that for periodontal disease tend to increase anteriorly.
An outbreak of yaws consisting of ten active cases in Baling is described. Yaws should be suspected and considered in the differential diagnosis of sores in the limbs of children living in rural areas. The clinical features of yaws are highlighted to help in the recognition of the condition for those unfamiliar with the condition.
A stable population at risk of Malaysian schistosomiasis was studied. Census results indicated that approximately one-fourth of the inhabitants used a stream where Schistosoma malayensis-infected snails were present as their principal source of water for bathing, drinking, and household tasks. The general population also contacted this stream when fording it or while fishing. Serological surveys using enzyme-linked immunosorbent assay (ELISA) and the circumoval precipitin (COP) test revealed six (9%) and three (4%) positives, respectively, among 67 persons examined. No schistosome ova were found in a general survey of 56 persons which included five ELISA positive and two COP test positive patients. ELISA and COP test prevalences among those dependent on the foci of transmission for water, 13 and 7% respectively, were only slightly higher than prevalences among the remainder of the population, 8 and 4% respectively. These results indicate that even among a stable population at risk of Malaysian schistosomiasis the prevalence is low. Our findings support the hypothesis that S. malayensis is a zoonotic infection in man and that it is unlikely to become a significant public health problem.
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%.
A total of 62 patients with vesico-urethral dysfunction were investigated at the Urodynamic Laboratory (Universiti Kebangsaan Malaysia) at the Institute of Urology and Nephrology over a period of eleven months in 1985. In most instances the results significantly influenced a change in patient management strategy. These results are analysed and the usefulness and limitations of this modality of investigations are critically alluded to.
One hundred and forty-one Penans from three longhouses along the Melinau and Terawan Rivers, Baram, Sarawak were examined. The number of decayed, missing and filled teeth was determined for each subject. The number of Penans who wore dentures was noted likewise the number of Penans who brush their teeth was recorded. The relationship between these findings and their possible causes are discussed.
A retrospective study of 34 patients with supracondylar-condylar fractures of the femur admitted to the Alexandra Hospital, Singapore, from January 1979 to December 1983 was carried out. These fractures were surgically treated by AO principles and fixation, and the surgery performed mainly by the two authors. Using strict criteria adopted from Schatzker of Toronto, 1 it was found that 62% of patients had excellent/ good results. The importance of treating supracondylar-condylar fractures by AO principles and fixation is emphasised.
The purpose of this study was to assess M-mode echocardiographic criteria for pulmonary artery hypertension in patients with intracardiac shunts, and to observe any signs not previously described.
Forty-seven consecutive cardiac cathetherised patients with routine M-mode echocardiogram done were reviewed. Twenty-six patients had atrial septal defect, nine had ventricular septal defect (VSD), four had patent ductus arteriosus (PDA), five had Eisenmenger syndrome and three had combined VSD and PDA.
Fifteen of 20 patients with pulmonary artery mean pressure (PAMP) of more than 50 mmHg demonstrated diminished a-dip (p < 0.001), reduced e-f slope (p < 0.01) and increased b-e slope to > 380 mm/sec (p < 0.01). The presence of systolic flutter or mid-systolic notch, or both was not observed in patients with normal PAMP, but was noted in all of the 20 patients with raised pressure(> 50 mmHg).
This study confirms the limitation of M-mode echocardiographic features in the evaluation of pulmonary artery hypertension in patients with intracardiac shunt, though clinically useful.
40 cases of major renal trauma over a period of five years in a peripheral hospital in Singapore were reviewed. 90% were due to blunt trauma with motor-cycle accidents forming the majority. There were five cases of superficial cortical injury, three cases of shattered kidneys, six cases of parenchymal injuries, one case of pedicle injury and one case of combined pedicle and parenchymal injury. Nephrectomy rate was 22.5% in this series. This is felt to be unduly high. Half of all the cases operated upon ended up with an immediate total nephrectomy. There was no mortality in this series. We recommend a more conservative policy of watchful waiting to achieve better chances of organ preservation without increasing mortality.
The complications of temporary transvenous endocardial pacing as performed in the University Hospital Kuala Lumpur, from 1971 to 1979 were reviewed. 125 temporary pacings were performed in 111 patients. Different routes of temporary pacing
were used: namely percutaneous subclavian vein and femoral vein puncture and acutecubital vein cutdown. The latter route was associated with a higher incidence of dislodgement and infection. Other common complications encountered were ventricular arrhythymia and generator failure.
A retrospective study of the indications for temporary transvenous pacing in the University Hospital, Kuala Lumpur, from 1971 to 1979 is reviewed. There were 111 patients. The main indications for temporary transvenous pacing were, namely,complete heart block (57%), sick sinus syndrome (24%), Mobitz type 11 block (5%) and bifascicularblock (3%).
A double-antibody radioimmunoassay technique has been used to investigate the serum prolactin (hPRL) level in Malay females from premenarche to the postmenopause. The results showed that the hPRL level (mena ± SEM) in the premenarchal, postmenarchal and late pubertal/reproductive subjects were 23.6 ± 2.3, 19.1 ± 2.0 and 22.7 ± 1.9 ng/ml respectively. In premenopausal women, hPRL level (11.8 ± 2.4 ng/ml) was significantly reduced (p < 0.01) compared to that of late pubertal group; the level declined even further after menopause (9.5 ± 1.7 ng/ml). Although the difference in the mean prolactin levels between premenopause and postmenopause were not significant, 73% of the postmenopausal women had serum prolactin concentrations below 10 ng/ml compared to 44% of the premenopausal and 10% in late pubertal group.
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.
Hereditary haemolytic anaemias have been found to be a significant cause of haemolytic disease in West Malaysia. This paper reports a micromapping study of 916 healthy Malay males from June to August 1983 to determine the distribution of the relevant thalassaemia genes in West Malaysia. Beta thalassaemia trait was found in 2.18%, HbE 3.49% and alpha thal2 (alpha+) trait in 26%. Of the sixteen transfusion dependant Malay thalassaemic patients at the Paediatric Unit, National University of Malaysia, eight patients had HbE beta thalassaemia and the rest are beta thalassaemia major; these patients who are transfusion dependant receive inadequate treatment. Prevention is the only resort.