The clinical, biochemical and immunological features of 180 patients with hyperthyroid Graves' disease managed at the Universiti Kebangsaan Malaysia (UKM) Endocrine Clinic from 1983 to 1987 were examined. The prevalence of the disease is highest in Chinese and lowest in Indians. The female: male ratio is 2.8:1. Hypokalaemic periodic paralysis and hypercalcaemia were present in 5.0% and 1.7% of the cases respectively. Pretibial myxoedema was extremely rare. Thyrotropin - binding inhibitory immunoglobulins, anti-thyroglobulin and anti-microsome antibodies were positive in 61.5%, 25.8% and 42.3% of the patients respectively. A eumetabolic state could be achieved in the majority of patients with antithyroid drugs alone. Definitive therapy with subtotal thyroidectomy or radioiodine were needed in 31.3% of cases.
The aim of this study is to determine the social impact of oral and facial pain in a sample involving an industrial population. Out of a total of 355 subjects interviewed, nearly one-half claimed to have oral and facial pain in the previous one month prior to the survey. The most common type of pain was that related to hot or cold fluids or sweet things followed by toothache. On the average, the pain lasted for 4.2 days (SD = 4.9) per person in the past one-month. About one in five persons with pain reported that it was severe enough to disrupt sleep. About one in ten persons reporting pain had to take sick leave because of the pain. However, only one in four persons with pain consulted a doctor or dentist. More than one-third tried to cope with the pain and did nothing while the rest tried various means of self-cure. It is therefore postulated that in this population, pain per se is a poor predictor of utilisation of dental services. Further research into pain coping behaviour and how this affects of pattern of utilisation of dental services is indicated in order to formulate a strategy to encourage the habit of seeking prompt dental care by the target population.
Hereditary stomatocytic ovalocytosis and haemoglobin E are two genes present in 3-5% of Malays. This is a report of a 22 year old Malay college student with homozygous haemoglobin E and hereditary stomatocytic ovalocytosis where the clinical effects seen were the result of the summation of these genes: he was asymptomatic, presenting with moderate jaundice, moderate hepatosplenomegaly, and a mild haemolytic anaemia.
The histological location of amyloid within various organs in 25 cases of systemic AA amyloidosis was studied with a view to determine whether different morphological patterns exist in this category of amyloidosis. Although morphological variations due to progressive severity of disease were observed, there were appreciable variations in the patterns of amyloid deposition in the kidney and spleen that could not be simply explained on those grounds. Eleven (61%) of 18 kidneys examined showed severe glomerular involvement with mild degrees of vascular deposition while the remaining seven showed predominantly vascular involvement. The glomerular pattern appeared to be more ominous, being significantly associated with severe proteinuria or chronic renal failure. In nine (69%) of 13 spleens examined, amyloid was confined to the walls of small and medium-sized arteries while in the remaining four, vascular involvement was less severe and amyloid was deposited mainly along the reticulin of the white pulp. Possible explanations for these different patterns included resorption and redistribution of amyloid within the body during the course of the disease, and variation in tissue deposition as a manifestation of polymorphism of amyloid proteins. The latter appeared more feasible in view of the recent demonstration of SAA polymorphism and AA heterogeneity in man.
Forty-five Asian patients (Indians 35, Chinese 8, Malay 2) with histologically proven lichen planus were studied by immunofluorescence. The most characteristic feature, seen in 93% of the cases, was shaggy deposition of fibrinogen along the basement membrane. Immunoglobulin deposition along the basement membrane was notably, absent. Colloid bodies were observed in 87% of the cases. Fibrinogen was the most common immunoreactant, and its presence in colloid bodies was always associated with fibrinogen deposition along the basement membrane zone. Colloid bodies also contained a variety of other immunoreactants. However, staining for IgM was noted to be the most intense. The combination of shaggy deposition of fibrinogen along the basement membrane, in the absence of immunoglobulins, and the presence of colloid bodies around the basement membrane zone, is highly characteristic of lichen planus. The pattern of immunofluorescence among Asians with lichen planus, conforms to that observed in other races. There did not appear to be any difference in the immunofluorescence staining with pattern in the three racial groups studied.
Between 1981 and 1986, 10 consecutive cases of melioidosis were seen at the University Hospital, Kuala Lumpur, Malaysia. They illustrate the amazing guises of melioidosis presenting as: abscesses of the supraspinatus muscle, psoas muscle, brain and liver; three different pulmonary forms; an acute suppurative dermal lesion; an acute septicaemia; and chronic lymphadenitis. The majority had underlying diseases: diabetes mellitus, the commonest, was present in six, out of whom three had previous pulmonary tuberculosis; other predisposing conditions were renal failure, corticosteroid therapy and malnutrition. Three patients who died had pre-existing renal impairment and developed renal failure later, suggesting that the former is a bad prognostic sign. Clinical diagnosis was difficult: all cases were diagnosed bacteriologically. A high level of clinical awareness is necessary, especially when presentation simulates pulmonary or extrapulmonary tuberculosis in patients with diabetes or other compromised states.
Demonstration of arrested intracerebral blood flow is the ultimate evidence of brain death. Computerized radionuclide cerebral flow study was done on 18 patients diagnosed clinically as brain dead. Correlation was made with clinical neurophysiological and EEG findings. The criteria for diagnosis of arrested intracerebral perfusion using radionuclide flow study were: non-visualization of blood flow activity in the intracranial arteries during the arterial phase, diffused cerebral activity during the capillary phase and non-filling of venous sinuses during the venous phase; visualization of typical 'hot nasal' activity; the time activity curve over the cerebral hemispheres lacks a bolus effect and instead shows a delayed gradual rise of activity. These features are pathognomonic of brain tamponade.
Arrested intracranial circulation was seen in 16 patients (ten had electrocerebral silence; one had extremely abnormal EEG with small voltage activity and five had no EEG done). In the remaining two patients, some cerebral blood flow was demonstrated (one had no definite cerebral activity and the other had diffused EEG activity).
Radionuclide cerebral flow study is a very sensitive, accurate, safe, simple, rapid and non-invasive modality in confirming brain death and is especially useful in patients on "brain-protection" regime, in hypothermia or in certain metabolic states where diagnosis based on clinical and EEG criteria is difficult. EEG need not be a required procedure once brain death is established by the demonstration of arrested intracranial circulation.
The morphology, incidence and distribution of hyaline cells in ten cases each of pleomorphic adenoma, adenoid cystic carcinoma, adenocarcinoma and mucoepidermoid tumour were studied by conventional light microscopy. Results showed that the hyaline cells were identified in 60% of pleomorphic adenoma and in 20% of mucoepidermoid tumours, but were absent in adenoid cystic carcinoma and adenocarcinoma. Relative area estimation of hyaline cells in pleomorphic adenomas showed that this may range from 2.2% to 30.4% of the total tumour area. The usefulness of the hyaline cell as a diagnostic criteria in distinguishing between some of the salivary gland tumours was also discussed.
Possession-trance is a common culture-bound syndrome in Singapore. The characteristic features as seen in 36 young men of the three different ethnic communities are described. At follow-up four to five years later, none of the 26 who could be contacted showed any evidence of mental illness. The psychopathology of the possession-trance is discussed.
A patient with a solitary intracranial cryptococcoma of the occipital lobe of the brain and a concomitant granuloma of similar aetiology in the breast is reported. Despite resistance of the causative fungus to 5-fluorocytosine in vitro, the patient responded well to radical excisional surgery and therapy with 5-fluorocytosine.
A descriptive epidemiology of cancer in Sarawak, based on histopathology records in the Central Medical Laboratory, Kuching, Sarawsk, in 1981 and 1982 was presented. There were 8,219 patients from whom biopsies were taken and 485 from whom marrow biopsies were taken. Out of these, 1,326 were reported malignant. Most of the cases were from Kuching. There were slightly more males than females. The Chinese formed the majority of cases followed by the Sea Dayaks and Malays. The most common cancer sites among males were lymph nodes, nasopharynx, skin and stomach, while in the females the most common sites were the breast, cervix and lymph nodes. Among the Chinese the most common cancers were those of the nasopharynx in males, and breast in females. Among the Sea Dayaks, the most common cancers were those of the lymph nodes in males and cervix in females. Among the Malays, skin cancers were relatively common, and among the Land Dayaks nasopharyngeal cancers were common. Most of the patients were in the older age groups. The pattern of cancers has not changed much since 1966 and the findings of the present study are very similar to the series from the Institute of Medical Research, Kuala Lumpur, in 1969 to 1971.
The concentrations of non-haem iron, ferritin and ferritin-iron were measured in the livers of 137 adults and children collected at necropsy. The concentrations of non-haem and ferritin iron were found to be 146.6 +/- 95.2 micrograms/g and 61.6 +/- 32.4 micrograms/g, respectively, in males and 108.0 +/- 61.7 micrograms/g and 60.6 +/- 26.4 micrograms/g, respectively, in females. The values for males in Singapore were lower than those reported in developed Western countries. No correlation was observed between storage iron and age, or ferritin concentration and age. Concentrations of non-haem iron and ferritin were similar for persons dying from accident and coronary heart disease. The non-haem iron concentration in Chinese (187.9 +/- 101.0 micrograms/g) was significantly greater than that in Indians (103.1 +/- 65.8 micrograms/g), while the ferritin concentration in Chinese (6.18 +/- 2.37 mg/g) was significantly greater than either Malays (3.81 +/- 1.8 mg/g) or Indians (3.52 +/- 1.6 mg/g). A significant positive correlation was observed between the non-haem iron and ferritin and also ferritin-iron in Chinese males (r values of 0.678 and 0.598, respectively) and Indian males (r values of 0.576 and 0.612, respectively). However, the correlation between these indices was not significant in the case of Malay males. In premenopausal women the non-haem iron correlated well with ferritin (r = 0.737) and ferritin iron (r = 0.826) while the correlation was lacking in postmenopausal women.
This study has analyzed 260 patients with multiple injuries sustained in road accidents admitted to the University Hospital during the period July 1967 to July 1976, in relation to age, sex, and ethnic distribution. The types of injuries sustained have been discussed to highlight their effects on the community in a developing country. The extremities have been most frequently involved, while head injuries followed closely. The causative factors of multiple injury-producing accidents have been evaluated. The categories of victims most liable to multiple injuries have been discussed. The significance of understanding the mechanism of these accidents and the effect of such knowledge in minimizing diagnostic errors, thus enabling management and the urgent need for regional accident services in developing countries, have been stressed.
Perforated appendix is a serious surgical condition that carries a high morbidity. Antibiotic treatment is often started before the availability of bacteriological reports. The choice of antibiotics would depend on the bacteriology associated with perforated appendix. In a retrospective survey of the bacteriology of peritoneal pus obtained from cases of perforated appendix at the General Hospital, Kuala Lumpur, E. coli was found to be the most commonly encountered organism. This was followed in order of decreasing frequency by streptococci, Bacteroides species, Klebsiella-Enterobacter group and Pseudomonas aeruginosa. From the results of the antibiotic sensitivities an antibiotic regimen comprising of a combination of gentamicin, metronidazole and penicillin is recommended as appropriate chemotherapy in perforated appendix.
Five patients were bitten by the Malayan krait Bungarus candidus (Linnaeus) in eastern Thailand or north western Malaya. Two patients were not envenomed but the other three developed generalised paralysis which progressed to respiratory paralysis in two cases, one of which ended fatally. One patient showed parasympathetic abnormalities. Anticholinesterase produced a dramatic improvement in one patient. Another patient probably benefited from paraspecific antivenom. The efficacy of antivenoms and adjuvants such as anticholinesterases in patients with neurotoxic envenoming requires further study.
Patients attending a referral Skin Clinic were studied to identify the spectrum of drug eruptions and the offending drugs. There were 51 patients with an incidence of five per thousand and equal sex incidence. Though the pattern of eruption was broadly similar to other reports, unusual reactions were observed. In addition to the skin manifestation, fever and lymphadenopathy were present in most patients. Raised erythrocyte sedimentation rate and eosinopoenia were commonly observed. Clinical acumen and the list of drugs ingested are still the best clues to the diagnosis ofdrug eruption.
Study site: Skin clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia