This article consists of two selected case reports of a recently named odontogenic tumour, unicystic ameloblastoma. The clinical and radiographic findings of the two cases mimic that of odontogenic cysts but not dentigerous cysts as in most reported, cases. Histologically, either a normal or ameloblastomatous cyst lining is evident. Other features of ameloblastoma are present within the cyst wall or as luminal nodules within the cystic space. A review of the literature indicates that this is a non-aggressive tumour with a low recurrence rate.
Sera obtained from 3,472 persons in Malaysia, Thailand, Philippines and Indonesia were tested for the presence of antibody to adult T-cell leukemia-associated antigen by the gelatin particle agglutination test and indirect immunofluorescence. Among these, only two seropositives were identified. One was a 30-year-old male Malaysian of Indian origin. The other was a 42-year-old female Thai who resided in Bangkok. These results suggested that the infection of human T-lymphotropic virus type 1 might not be endemic in these countries.
The relief of pain is of crucial importance in the management of patients undergoing a total three-stage oesophagectomy. Respiratory problems as a result of inadequate or overzealous analgesic regimes can ruin all pre-operative and per-operative efforts. 90 patients who underwent a total oesophagectomy over a 15-year period (1967-1982) at University Hospital Kuala Lumpur, were reviewed (36 for benign stricture and 54 for carcinoma of the oesophagus). Four post-operative analgesic regimes were used: immediate extubation and parenteral analgesics; 24-48 hour IPPV and timed dose/continuous infusion of parenteral narcotics; 24-48 hour IPPV plus extradural catheter analgesia; intra-operative direct intercostal nerve blocks, extubation and parenteral analgesics. Morbidities and mortalities are analysed.
In a study of suicide in Singapore in 1980 there were 230 cases and the suicide rate for the general population was 9.5 per 100,000. The age-specific rates increased steeply after 50 years and there was a male preponderance especially in the age group 60 years and over. Comparing the three major ethnic groups in Singapore, the highest rate was seen in the Indians and Chinese, whereas the Malays had the lowest. Amongst the suicides there were 59 (25.7%) with mental illness, mainly schizophrenia, and they were of a younger age group, 20-39 years. The commonest method of suicide was jumping from high-rise flats.
Asthmatic patients constitute up to 5% of admissions to medical wards in our area. Analysis of 1099 adult asthmatic admissions over a 3-year period showed that Malays composed 31% of patients (expected 23%), Indians composed 36% (expected 31%) and Chinese only 32% (expected 46%). There was a reduced prevalence of asthma in the Chinese (P less than 0.001). Male asthmatic admissions showed a non-seasonal cyclic variation (P less than 0.01) with an increasing trend in the number of admissions (P less than 0.02). The proportion of male to female asthmatic admissions did not differ. In a sample of 50 asthmatic patients, studied in detail, the mean age of onset was 33.3 years (range 6-74) while only 14% of subjects had onset of asthma before the age of 10 years. Although the clinical features of these patients differ from those of Caucasian asthmatics, skin prick tests and other features suggest that the majority of our patients suffer from extrinsic atopic asthma.
Study site: Hospital [unknown], Pulau Pinang, Malaysia
This paper presents evidence from the Malaysian Family Life Survey that mothers' reports of their babies' birthweights, including reports of unweighed babies' approximate size at birth, can be used to examine many biological and socioeconomic correlates of birthweight. The study uses a sample of 5583 singleton births that occurred between 1945 and 1976. In these data, the frequency distribution of birthweights and their bivariate and multivariate relationships with the biological correlates of mother's age, baby's sex, first parity and infant mortality are consistent with those found in prospective studies. A new biological correlate, mother's age at menarche, is introduced as a proxy for the mother's nutrition during childhood. Late age at menarche is associated with lower birthweight. Other results show mothers younger than 20 years and older than 35 appear to be at greater risk of bearing small babies, but the former effect is no longer important when parity is controlled. Short interbirth intervals are associated with small babies. We attempt to distinguish whether this is due to prematurity or to maternal nutritional depletion; both effects appear to be operating. Higher income appears to mitigate the pernicious effect of short interbirth intervals. Indian babies weigh significantly less than those of other ethnic groups. Furthermore, birthweights have increased since the 1950s for Malays and Chinese, but not for Indians. The lower birthweights and lack of improvement over time for Indians appear to be due to close birthspacing, lack of access to medical care and falling incomes.
Caesarean hysterectomy is a useful surgical procedure. However, the increased blood supply to the pelvis during pregnancy, distortion of the anatomy caused by the enlarged uterus, fragility of oedematous pelvic tissues and adhesions from prior caesarean sections predispose to poor haemostasis and urinary tract injuries. In this series all the cases were done as an emergency procedure and, despite the multiple obstetric complications, there was no maternal mortality and the incidence of post-operative morbidity was low.
Diarrhoea up till now is still a major problem in Southeast Asia with high morbidity and mortality, particularly among children under 5 years of age, with the peak in children between 6 - 24 months. In Indonesia, in 1981, it was estimated that there are 60 million episodes with 300,000 - 500,000 deaths. In the Philippines, diarrhoea ranks as a second cause of morbidity (600 per 100,000 in 1974) and second cause of infant mortality (5 per 1,000 in 1974). In Thailand, in 1980, the morbidity rate was 524 per 100,000 and the mortality rate 14 per 100,000. In Malaysia, in 1976, diarrhoea was still ranking number 5 (3.1%) as a cause of total admission and number 9 (2.2%) as a cause of total deaths. In Singapore, diarrhoea still ranks number 3 as a cause of deaths (4% of total deaths). In Bangladesh, the overall attack rates imply a prevalence of 2.0% for the entire population, with the highest for under 5 groups i.e. 4.1%. The diarrhoea episode in rural population is 85.4%, 39% of them are children under 5. The most common enteropathogens found in all countries are rotavirus followed by Enterotoxigenic E. coli, Vibrio spp., Salmonella spp., Shigella spp. and Campylobacter. Malnutrition and decline of giving breast-feeding play an important role in causing high morbidity, besides socio-economic, socio-cultural and poor environmental sanitation.
Over a five year period, 184 patients were treated for acute renal failure. Uraemia was usually treated by peritoneal dialysis, and haemodialysis was reserved for post surgical and hypercatabolic patients. The overall mortality was 33.2% and was highest among surgical patients. These results were similar to previous reports. Peritoneal dialysis was usually effective in controlling uraemia. Uncontrolled sepsis remains a major problem, and septicaemia and gastrointestinal bleeding were adverse factors affecting the outcome. The combination of septicaemia and gastrointestinal bleeding commonly led to a fatal outcome.
The indirect hemagglutination test was used to measure malaria antibody levels in residents of an endemic area of Malaysia. Blood specimens were collected at 4-week intervals for a year. Seropositivity rates increased with age and number of episodes of malaria in young children. Although antibody levels were variable, titers tended to rise with parasitemia and fall in the absence of detected parasites. In general, the serologic indices tended to reflect the parasitologic findings.
A cohort of 62 persons living in a malaria-endemic area was examined by serology and by blood film 14 times over a 56-week period. Serologic responses (indirect hemagglutination test) of the group as a whole reflected the malaria transmission as determined by blood slide examination. The serologic responses of individuals showed titer changes that were not always consistent with blood slide results. The use of chloroquine may have modified the host's immune response.
Concerned by the alarming decline in breast feeding in the urban and rural areas of Malaysia, we conducted a critical review of infant feeding practices among nursing personnel from representative centres using questionnaires. It was found that although 75% of mothers breast-fed their babies at birth only 19% did so at 2 months and 5% at 6 months respectively. Chinese mothers initiated breast feeding less frequently compared with Indian or Malay mothers. The prevalence of breast feeding was higher among lower category nurses, lower income groups and those from health centres. Decision for breast feeding was based in most instances on conviction derived from reading, lectures or advice from relatives. The vast majority of mothers listed "work' as the main reason for termination of breast feeding followed by "insufficient breast milk' and satisfactory past experience with bottle feeding. The ramifications of these findings and measures to improve the prevalence and duration of breast feeding are discussed.
The present paper is the third and concluding part of a study of the secondary school population of two of Malaysia's thirteen states, Penang and Selangor. Since completion of the two earlier papers, the research team has investigated the pattern and nature of drug use among the equivalent population in a third state, Kelantan, and has again found essentially the same pattern of results: youthful drug use is most clearly related to precocious self-assertion, and a set of beliefs and attitudes about drugs and drug taking, and is largely unrelated to indicators of social deprivation or personal problems. The significance of this repeated finding in Kelantan is that, in this much more rural and traditional state, adult and established patterns of drug use had historically differed considerably from those found in the two more urban and cosmopolitan states of Penang and Selangor. Our findings indicate that the new pattern of drug use by youth has transcended the older cultural differences between the states, and is in turn explained by a more universally familiar set of characteristics in adolescent development.
Those Malaysian secondary schoolchildren who have ever used an illicit drug do not differ significantly in terms of social class background, ethnicity or rural/urban location, from the majority of their contemporaries who have not used drugs. The cross-sectional data show a rapid secular trend towards the sexes being equally involved in drug use. Significant differences between ever and never users are, however, found in their attitudes towards drug taking and their beliefs about the properties of drugs, although both groups share the same rather negative image of the typical drug user. Thus, drug users have accepted some of the attitudes towards drug issues which are normative in the non-user group, whilst developing other attitudes which are consistent with their continuing use. It is argued that adolescent drug abuse in Malaysia is not to be linked specifically with social deprivation, but should be seen as being part of the life style of particular groups in all strata of society.
Between January and August, 1989, 36 men and 28 women with uncomplicated lower genital tract infections by Neisseria gonorrhoeae were given single intramuscular injections of sulbactam (500 mg)/ampicillin (1000 mg) together with 1 g oral probenecid. Cure rates that were obtained were 100% for women, 97.2% for men, 100% for patients with penicillinase-producing Neisseria gonorrhoeae (PPNG), and 98.4% for patients with non-PPNG. No serious side effects were encountered, and patient acceptance of the drug was good. A high proportion of patients had concurrent chlamydial infection. Sulbactam/ampicillin was found to be effective against gonococcal urethritis and cervicitis by both PPNG and non-PPNG but have little effect on concomitant chlamydial infections, especially in women.
Seventeen consecutive patients with dystrophic amyloidosis are reported here (eight Chinese, three Indian, three Iban, two Malay and one Caucasian). Ten were females and seven males, with ages ranging from 12 to 80 years (mean of 48 years). Five instances of dystrophic amyloidosis occurred in areas of tissue damage in the cardiovascular system, including fibrotic cardiac valves and an atheromatous plaque. Three occurred in osteoarthritic joint tissue. Of note were three occurrences in endometriotic cyst walls, four in the fibrotic walls of epidermal cysts, one in a hernial sac and one at the edge of a skin ulcer. All deposits were congophilic and exhibited green-birefringence and permanganate-resistance. Immunohistochemistry did not reveal reactivity for AA protein or immunoglobulin lambda or kappa light-chains. AP protein was detected in 35% of cases. Our results show that, besides the usual sites of osteoarthritic joints and damaged heart valves, dystrophic amyloidosis can complicate other areas of chronic tissue damage and fibrosis such as walls of cysts and ulcers. While the pathogenesis and biochemical nature remain unresolved, immunohistochemistry indicates that neither AA nor AL proteins are present in the deposits, and suggests that a different amyloid protein is involved.
Twenty-nine adult patients with culture-positive thoracic empyema were seen at the University Hospital Kuala Lumpur from 1984 to 1988. Cough, fever, chest pain, dyspnoea and weight loss were the common presenting symptoms. The empyema in 16 patients was associated with primary bronchopulmonary infections, nine occurred following thoracentesis of culture-sterile pleural effusions, two occurred as post-thoracic surgery complications, one following a subdiaphragmatic abscess and one as a result of a stab wound. The most common culture isolates were Streptococcus milleri, Pseudomonas aeruginosa and Klebsiella pneumoniae. Closed tube thoracostomy, the most common form of drainage procedure employed, was able to effect a cure or control of the empyema in 11 out of 19 patients in whom it was used.