Thirty-one (31) patients undergoing electroconvulsive therapy (ECT) over a three-week period in October 1982 in the Psychiatric Unit, University Hospital, Kuala Lumpur, were studied. The main indications for ECT in these patients were poor response to drug therapy, depression with suicidal ideation, and aggression, which together accounted for 87 percent of all patients started on ECT during this period. The majority of patients (86 percent) showed some improvement, and 73 percent improved by the third ECT. The most common side-effects experienced by patients were memory disturbance (45 percent) and post ECT headache (45 percent). No serious side-effects were encountered.
Three cases of acute psychosis during pregnancy had been treated with electroconvulsive therapy (ECT) during their stay in hospital, due to their slow response to anti-psychotic medication. All three responded well to the treatment and two subsequently delivered normal healthy infants and they did not suffer maternal complications. The authors feel that ECT is as safe, if not safer than the use of high dosage of anti-psychotic medication and a review of the world literature appears to confirm this view. In addition, the psychotic process usually settles faster with the use of ECT than with the use of anti-psychotic drugs.
Pectoralis major myocutaneous flap reconstruction of the defect following surgery for oral cancer in fourteen patients is described. The problems and complications encountered have been found to be minimal. Functional and cosmetic results were acceptable.
This study shows that out of 774 patients tested, the house dust mite (Dermatophagoides pteronyssinus) provoked the maximum response (51.81%) the house dust was second (42.81%), and shrimp was third (23.92%). The moderate allergenic extracts were cat fur (12.79%), dog fur (10.72%), cockroach (8.47%) egg white (7.56%) and orris powder (6.30%). Among the low allergenic extracts were Aspergillus fumigatus (5.38%), Staphyloccus aureaus (3.53%) and chicken feathers (3.18%). The authors are of the opinion that the skin sensitivity test is an important diagnostic tool in allergic rhinitis and since this is a preliminary study any short listing of allergens to be used is not recommended yet. Skin sensitivity tests is a useful tool for differentiating allergic rhinitis from vasomotor rhinitis. Estimation of allergen specific IgE concentration in the serum will not offer any major advantages over the intradermal skin test in determining the clinical significance of house dust mite allergy. 21 The development of local materials for skin testing may enhance the usefulness of these investigations.
A three and a half year old boy with shigellosis developed fulminant hepatic failure. The hepatic derangements rapidly improved over a period of two weeks after treatment of the shigellosis with parenteral gentamicin. We believe this is the first documented report of fulminant hepatic failure due to shigella sepsis.
This communication describes the quantitative and qualitative analysis of oestrogen receptors in breast tumour biopsies of Malaysian patients. This preliminary investigation establishes certain rigid criteria that makes possible the classification of patients most likely to respond to hormonal therapy. 20 percent of the patients had oestrogen receptor positive tumours while 60 percent were oestrogen receptor negative.
A 23 year old Indian lady, gravida 1 para 0, with Clomid induced pregnancy was admitted to the University Hospital on 29 August 1981 with signs and symptoms of pregnancy and intraperitoneal bleed. Period ofamenorrhoea at time of admission was eight weeks. Emergency laparotomy revealed a right leaking ectopic pregnancy and an enlarged gravid uterus. Ultrasound done on the 7th post operative day confirmed concurrent intrauterine pregnancy which progressed normally to term, ending with a normal healthy baby at 39 weeks through an assisted breech delivery.
Two cases of Hypomelanosis of Ito are described; presenting with depigmented whorl-like, zig-zag, bizzare cutaneous manifestations associated with central nervous system disorders.
An interesting case is described here in which partial airway obstruction resulted in sleep apnoea and which was relieved by adeno-tonsillectomy. Enlarged tonsils and adenoids causing upper airway obstruction represent one facet of a continuum of hypoventilation - sleep disorders and clinical examination with x-rays will help in determining patients at risk of developing these syndromes.
Forty nine patients with sick sinus syndrome seen at the University Hospital, Kuala Lumpur are reviewed. The ages of patients ranged from 17 to 85 years. There were 21 males and 28 females. The diagnostic criteria were sinus bradycardia in 8 patients (Group I), sinus arrest or sinoatrial block in 24 patients. (Group Il), and bradycardia tachycardia syndrome in 17 patiens (Group Ill). The aetiology was unknown in the majority of patients. Ischaemic heart disease was the commonest known aetiological factor. Patients with symptomatic sinus bradycardia and sinus arrest were initially treated with oral isoprenaline, and if this failed, they were paced. Temporary transvenous pacing was necessary in 27 patients and subsequent permanent pacing performed on 23 patients.
The isolation of a penicillm. resistant strain of Streptococcus pneumoniae is being reported and indicates the need to screen pneumococcal isolates for resistance towards antibiotics.
Two cases of oral speckled leukoplakia with differing behaviour are presented. This precancerous lesion of unknown aetiology requires early diagnosis for proper management. Candida albicans are frequently found in these lesions. The significance of epithelial dysplasia in relation to treatment is discussed. Surgical removal is the treatment of choice.
A 31 year old Chinese man developed the nephrotic syndrome, and wasfound to have some of the clinical features of renal vein thrombosis such as a rapid deterioration in renal function and great variability in proteinuria. Radiological studies confirmed the diagnosis of bilateral renal vein thrombosis. The clinical features and pathogenesis of renal vein thrombosis are discussed.
Two cases of Actinomycosis of the spine with paraparesis are reported. The characteristic radiological features involving both the vertebral bodies and the ribs are seen. Confirmation by means of histopathology and culture was necessary and both patients responded well to penicillin.
During the period 1979-1982, 70 strains of atypical mycobacteria isolated from clinical material were identified as belonging to species or species complex. Twenty-eight out of 61 strains isolated from pulmonary specimens were identified as M. avium-intracellulare. This frequency of association of M. avium-intracellulare with sputa of patients with pulmonary symptoms points to its potential importance and the need for further investigation.
Bacterial isolates were made from the intestinal tracts ofcarious species of cockroaches (Periplaneta americana, Periplaneta brunnea, Periplaneta australasiae, Neostylopyga rhombifolia, Nauphoeta cinerea) trapped from kitchens and stores (houses and hospital), Shigello, flexneri, Salmonella typhi, Escherichia coli and Salmonella sp. were some of the bacteria isolated and identified.
An analysis of 86 patients sterilized laparoscopically with Hulka clips is presented. We find that the method is simple, acceptable and has minimal complication. The failure rate is similar to that reported by others. However, this method could be done under local anaesthesia thus shortening the hospital stay for the patients. This method has the advantage of safety and prospects for reversal when desired.