Cytokines are central to the development of effective immunity against microbial pathogens and their beneficial effects in the control of a variety of infections of man and animals are well-documented. However, it appears that cytokines may also have detrimental effects in infections by actually enhancing microbial growth. These observations emphasise the fact that many successful pathogens possess mechanisms enabling them to evade the immune response and that caution needs to be exercised in using cytokines as therapeutic agents to control infections in various human diseases.
The association of arsenical poisoning with the development of skin cancer is well-known. In Malaysia, arsenic has been shown to coexist with tin in tin-mining land. Our preliminary investigation has shown that the level of arsenic in well water from a tin-mining area is high. We report 3 patients with cutaneous lesions typical of chronic arsenical poisoning such as hyperpigmentation, keratoses and skin cancer. These patients have positive histories of previous domicility in tin-mining areas. We conclude that these patients developed chronic arsenical poisoning from drinking well water polluted with arsenic from the tin-mining soil.
The objective of this two year retrospective study is to find out the pattern of ovarian tumours among Malaysian women. A total of 280 cases were reviewed. Of these 193 were benign, 81 were malignant and six cases belonged to borderline malignancy. In the general population, equal distribution of serous and mucinous tumours among the benign (15.4%) and malignant (4.3%) types is quite a striking feature. The teratomas were the commonest benign tumour among the Malays and Chinese. Serous cystadenomas were the commonest among the Indians. The Malays had higher incidence of malignant epithelial tumours whereas the Chinese had a higher incidence of metastatic and germ cell tumours. Endometroid tumours occurred from an earlier age of thirty years. There was a preponderance of mucinous tumours among the borderline variety.
Three clinical cases of fungal corneal ulcers are described to highlight the course, ocular morbidity and principles of treatment. A brief discussion of the diagnosis and management of ulcerative keratomycosis is presented.
We report here a rare case of bilateral pure gonadoblastoma which accounts for only 0.2% of all ovarian tumours seen at Universiti Kebangsaan Malaysia from 1980 to 1987. This tumour occurred in an 18 year old Chinese "female" who presented with primary amenorrhoea. Examination showed a phenotypic female with poorly developed external gentalia. Exploratory laparotomy revealed a hypoplastic uterus, rudimentary fallopian tubes and streak gonads. Histological examination of the gonads showed a mixed tumour comprising large germ cells and smaller sex cord derivatives arranged in characteristic nests or islands containing hyaline material.
The microbial aetiology of genital ulcers was studied in 249 patients (241 men and 8 women) attending a Sexually Transmitted Disease Clinic in Kuala Lumpur, Malaysia. Herpes simplex virus type 2 was isolated in 48 (19.2%) patients, Haemophilus ducreyi from 22 (8.8%), Neisseria gonorrhoeae from seven (2.8%) and Chlamydia trachomatis from four (1.6%). Syphilis was diagnosed in 18 (7.2%) patients on the basis of dark field microscopy. Two (0.8%) patients were found to have both chancroid and syphilis and one (0.5%) had both gonorrhoea and syphilis. No organism was isolated in the remaining 151 (61.5%) patients. Overall, the accuracy of clinical diagnosis was 58% for single infection, 67% for herpes, 63% for syphilis, 47% for chancroid and 0% for lymphogranuloma venereum. Therefore, our study confirms the need for laboratory tests to diagnose accurately the aetiology of genital ulcer disease.
We reviewed 31 cases (19 males and 12 females) of spinal tuberculosis seen at the National Tuberculosis Centre from 1985 to 1989. The mean age was 35.4 years. The predominant clinical feature was backache (90.3%), while neurological features were found in 30.9%. An elevated erythrocyte sedimentation rate (in 80.0%) and a positive Mantoux test (in 70.9%) served as useful investigations. Spinal x-ray was abnormal in all cases, the lumbar spine being most commonly involved. Bacteriological or histopathological confirmation was obtained in only 29.0% of cases. The mainstay of treatment was anti-tuberculous chemotherapy with surgery being performed in 41.9% of patients.
Pregnancies conceived through assisted reproduction can present considerable management problems to the obstetric and paediatric staff. Multiple pregnancies are common. The complication of prematurity increases the morbidity and mortality rates of the neonates.
This is a case report of ascaris worm in the common bile duct in a 61 year old lady. Ultrasound diagnosis was initially made based on the presence of linear hyperreflective foci within the common bile duct. ERCP confirmed a single worm within the duct. Balloon extraction was then successfully carried out following papillotomy. This case illustrates the value of ultrasound in the definitive diagnosis of biliary ascariasis and the therapeutic role of ERCP.
A self-administered questionnaire survey was conducted among sawmill managers in Sarawak to explore certain health and safety aspects of workers in this industry. The survey reveals that many sawmills are lacking in the provision of occupational health facilities and activities for their employees.
Using computerized in-patients' discharge records, a descriptive analysis was carried out of all medical admission in 1987 in a general hospital. The survey found that there were a total of 4053 admissions in 1987. A wide range of medical disorders were seen reflecting the lack of subspecialization. Cardiovascular disorders topped accounting for 25.6% of all admissions, followed by gastrointestinal and hepatobiliary disorders 12.8% and respiratory disorders 10.7%. The commonest specific medical disorders seen were hypertension 13.8%, diabetes mellitus 10.2%, ischaemic heart disease 7% and asthma 4.5%. The age, sex, ethnic and geographical distributions of the common medical disorders seen appear to conform to two broad pattern; hypertension, diabetes, ischaemic heart disease and cerebrovascular disease affected the older patients, had even ethic distribution and predominantly urban. Malaria, non-specific fever, viral hepatitis and acute gastroenteritis affected the younger patients, predominantly rural and Malay. Information from such surveys may be useful for planning and organization of medical services.
Congenital leukaemia which is characterised by proliferation and extrahaemopoietic infiltration of immature leucocyte precursor cells is a rare disorder encountered in the neonatal period. Although more than 100 cases of congenital leukaemia have been reported in the literature, the experience of most general paediatricians with this condition is very likely to be limited. Thus a patient presenting with congenital leukaemia admitted to Alor Star General Hospital is reported.
Three cases of occupational exposure to radio-frequency and microwave radiation were seen at the out-patient clinic, Hospital Universiti Sains Malaysia. They presented with run-down symptoms of neck strain associated with throbbing headache, irritability, loss of appetite, fatigue, memory difficulties, and numbness of extremities. They also presented with alopecia areata which is felt to be causally linked to the radiation exposure.
Study site: Outpatient clinic Hospital Universiti Sains Malaysia (HUSM)
Data on number of cases of acute asthma seen at casualty department in 1987 as well as daily metereological data for 1987 were obtained and analysed for relation between climatic factors and acute asthma. Ambient temperature was significantly associated with acute asthma; the lower the temperature, the more the number of cases of asthma were seen. No association however was observed between asthma and the other climatic factors viz, rainfall, humidity, daily change in humidity and daily drop in temperature. We further discuss our finding.
Speech audiometry is a method for assessing the ability of the auditory system using speech sounds as stimuli. A list of phonemically balanced bisyllabic consonant-vowel-consonant-vowel (c-v-c-v) Malay words was produced. All the bisyllabic words (c-v-c-v) thought to be commonly used in everyday conversations were listed from the Dewan Bahasa dictionary and their suitability assessed. The chosen words were divided into 25 groups containing 10 words each. The list was then recorded by a professional male newscaster in a sound proof studio. A normal speech audiometry curve was obtained by testing 60 normal hearing subjects using the prerecorded speech material. The result of the study showed that the normal Malay speech audiometry curve was comparable to those of English and Arabic speech audiometry, in which it was sigmoidal with the optimum discrimination score of 40 dB and half peak level of 17.5 dB.
An invasive mole causing uterine perforation is a rare occurrence. We describe below a case with an unusual presentation which was mistaken for an ovarian tumour. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.
A case of combined intra- and extra-uterine pregnancy is reported. Awareness of this condition, a high index of suspicion, the proper interpretation of physical signs and ultrasound findings together with early resort to laparoscopy resulted in a favourable outcome.
A 25 year old female presented with hypothyroidism which was followed by the development of hyperthyroidism about 1 1/2 years later. This uncommon phenomenon is postulated to result from changes in the relative amounts of stimulatory and inhibitory TSH receptor antibodies. This case illustrates the possible continuum between Graves' disease and Hashimoto's thyroiditis within the broad spectrum of autoimmune thyroid disease.
Study site: Primary care clinic. University Malaya Medical Cengtre (UMMC), Kuala Lumpur, Malaysia
We present a young lady who satisfied the criteria for the diagnosis of toxic-shock syndrome (TSS). The differential diagnoses of TSS in the local setting are outlined. The pertinent clinical features of TSS and its increasing association with nonmenstruating females are highlighted.
Ninety five patients with perennial rhinitis were examined clinically and various investigations were done in order to find out the common allergens and to assess the value of various tests in perennial rhinitis. In this study group 94% of cases were proven to be cases of allergic rhinitis. Cat fur was found to be the commonest allergen. Grass pollen which is a common allergen in European countries was found in only 18% of cases in the present study. X-ray of the paranasal sinuses as a routine investigation was not found to be of much use in perennial rhinitis. There was significant correlation between results for allergens tested by enzyme immunoassay and skin prick test.