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Florid peripheral stigmata of staphylococcus aureus infective endocarditis

Yew KL, Razali F

Acute Card Care, 2015;17(2):32.
PMID: 26458028 DOI: 10.3109/17482941.2015.1066822
Matched MeSH terms: Hemorrhage/pathology
Fulltext A strategy for reducing maternal mortality

Suleiman AB, Mathews A, Jegasothy R, Ali R, Kandiah N

Bull World Health Organ, 1999;77(2):190-3.
PMID: 10083722

A confidential system of enquiry into maternal mortality was introduced in Malaysia in 1991. The methods used and the findings obtained up to 1994 are reported below and an outline is given of the resulting recommendations and actions.
PIP: This is a report on the methods, findings, resulting recommendations and actions of a study on maternal mortality in Malaysia during the period 1991-94. Maternal death was defined as the death of a woman while pregnant or within 42 days following termination of pregnancy from any cause related to the pregnancy or its management but not from accidental causes. Between 1991 and 1994 there were 1066 reported maternal deaths, and the maternal mortality ratios for the successive years were respectively 44, 48, 46 and 39 per 100,000 live births. The primary causes of maternal death were postpartum hemorrhage (24%), hypertensive disorders of pregnancy (16%), obstetric pulmonary embolism (13%), and associated medical conditions (7%). Analysis of the 375 deaths from 1992 - 1993 showed that the maternal mortality ratio was 53/100,000 live births for deliveries performed at home, 36/100,000 in government hospitals, and 21/100,000 in private institutions. Shortcomings among health personnel were detected in several cases; these involved failure to diagnose, failure to appreciate the severity of a patient's condition, inadequate therapy, and inappropriate, delayed or failed adherence to protocols. The high proportion of maternal mortality associated with substandard care demonstrates that it is important to make the standard of care more widely available. Reports have been circulated to institutions and organizations providing maternal care and to medical schools. Articles and case histories have been published, and many new protocols and procedures have been developed. Furthermore, seminars have been organized and training modules have been distributed to all involved in the provision of maternity care.

Matched MeSH terms: Postpartum Hemorrhage/mortality
Fulltext Outpatient procedures for cervical dysplasia: a 3 year review of laser vaporisation and LEEP

Lee KE, Koh CF, Watt WF

Med J Malaysia, 1999 Mar;54(1):47-51.
PMID: 10972004

A 3 year retrospective review (1995 to 1997) of 127 patients with cervical dysplasia who underwent Laser Vaporisation of the cervix and LEEP at the Gynaecological Cancer Centre, KK Women's & Children's Hospital, Singapore, was undertaken. Amongst the patients in the Laser Vaporisation group, the mean age was 37.7 years (SD 8.8), the mean operating time was 14.8 minutes (SD 8.5), 63.6% were given prophylactic antibiotics and the mean follow up period was 15.3 months (SD 12.0), whilst in the LEEP group, mean age was 40.3 years (SD 8.4), mean operating time, 11.8 minutes (SD 4.9), prophylactic antibiotic rate, 53.8% and mean follow up period was 19.1 months (SD 9.3). Mild and moderate haemorrhage post procedure were the only complications encountered, 10.2% (5/49) in the Laser group and 3.8% (3/78) in the LEEP group. 98% (48/49) and 97.4% (76/78) of the Laser and LEEP groups, respectively, were free of disease on follow up. None of the 3 patients with persistent or recurrent disease were diagnosed as having invasive cancer. Overall, there were no significant differences in the patient characteristics, histopathology, operating times, follow up period, the use of prophylactic antibiotics, and complications in the 2 groups. The low complication rate, high disease-free rate and the relatively short operating time of Laser Vaporisation and LEEP in our study suggests that, indeed, both the procedures can be done safely and efficiently in the outpatient setting. However the discrepancy between the histology of colposcopically directed biopsy and that of LEEP specimens suggests that colposcopically directed biopsy may not be as accurate as one might believe, and further studies analysing the concordance between colposcopically directed biopsy and LEEP biopsy histologies are needed.

Matched MeSH terms: Uterine Hemorrhage/etiology
Fulltext A cervical ectopic masquerading as a molar pregnancy

Masir N, Tamby MR, Jamil MA

Med J Malaysia, 2000 Mar;55(1):138-40.
PMID: 11072500

We report a case of cervical pregnancy complicated by life threatening hemorrhage. An initial diagnosis of molar pregnancy was made preoperatively. During uterine evacuation she developed profuse hemorrhage which required an emergency hysterectomy for uncontrolled bleeding. Histopathological examination confirmed a cervical pregnancy. The clinical and pathological criteria for the diagnosis and the etiology of cervical pregnancy are discussed.

Matched MeSH terms: Postoperative Hemorrhage/surgery
Fulltext The yield for colorectal cancer and adenoma by indication at colonoscopy

Cheong KL, Roohi S, Jarmin R, Sagap I, Tong SHY, Qureshi A

Med J Malaysia, 2000 Dec;55(4):464-6.
PMID: 11221158

Colonoscopy is an integral part of the clinician armamentarium in the diagnosis of colorectal cancer and its precursor, the adenoma. Polypoid lesions when identified can be excised at colonoscopy and in turn reduce the risk of colorectal cancer. We prospectively evaluated the yield of colorectal cancer and adenomatous polyps by indication for colonoscopy over a one-year period. A total of 375 colonoscopies were carried out. The more common indications of colonoscopy were rectal bleeding, abdominal pain, surveillance of colorectal cancer and altered bowel habit. The highest yield for cancer was for rectal bleeding with 12.5% while surveillance of patients with a history of polyps yielded the highest percentage of new polyps. We conclude that rectal bleeding as an indication for colonoscopy yielded the highest number of cancers.

Matched MeSH terms: Hemorrhage/pathology
A validation study of the Siriraj Stroke Score

Kan CH, Lee SK, Low CS, Velusamy SS, Cheong I

Int J Clin Pract, 2000 Dec;54(10):645-6.
PMID: 11221275

A cross-sectional study was conducted on 160 Malaysian patients to validate the usefulness of the Siriraj Stroke Score (SSS) for differentiating intracerebral haemorrhage and infarction following acute strokes. Our results indicate that the score lacks sensitivity and specificity. It should thus not be used in epidemiological studies to determine stroke types in a community. More importantly, in the absence of information from neuroimaging of the brain, it cannot be used safely by physicians to assess the need or otherwise of thrombolytic and/or anticoagulant therapy after an acute stroke.

Matched MeSH terms: Cerebral Hemorrhage/diagnosis*
Predictive factors by multivariate analysis for colorectal cancer in Malaysian patients undergoing colonoscopy

Tan YM, Rosmawati M, Ranjeev P, Goh KL

J Gastroenterol Hepatol, 2002 Mar;17(3):281-4.
PMID: 11982698

BACKGROUND: The majority of colorectal cancers are still diagnosed in patients who present with symptoms especially in countries where colorectal screening programs are not practised. The aim of our study was to determine the predictive factors for colorectal cancer in patients referred for colonoscopy.
METHODS: A prospective study of 485 consecutive patients who underwent colonoscopy during a 22-month period was performed. All patients answered a detailed questionnaire. Indications for colonoscopy and the findings were recorded.
RESULTS: The mean age of the study population was 55.7 +/- 14.7 years. There were 221 (45.6%) males and 264 (54.4%) females. Sixty-five (13.4%) were Malays, 298 (61.4%) were Chinese and 112 (23.1%) were Indians. Multiple backward stepwise regression analysis revealed that independent predictors for colorectal cancer (odds ratio [95% CI]) were the presence of rectal bleeding (4.3 [4.0-8.0]) and iron deficiency anemia (4.0 [3.6-10.2]). In those aged 50 and over, male gender (4.5 [2.2-9.3]) and abdominal pain (3.1 [1.4-6.7]) were also significant positive predictors of cancer.
CONCLUSIONS: With the ever-increasing demand for gastrointestinal endoscopy, the appropriate utilization of colonoscopy is essential to afford prompt patient evaluation. Our study supports the need to prioritize the use of colonoscopy in patients with rectal bleeding and iron deficiency anemia. In the older patient where the background prevalence of colorectal cancer is higher, referral for colonoscopy is also justified.

Matched MeSH terms: Gastrointestinal Hemorrhage/epidemiology
Fulltext Clinical experience with management of "near-miss" cases in obstetrics

Sivalingam N, Looi KW

Med J Malaysia, 1999 Dec;54(4):496-503.
PMID: 11072469

Near-miss cases in life-threatening obstetric patients occurring over a one year period are analysed retrospectively with regards to morbidity measured in terms of hospital stay, utilisation of high dependency ward and intensive care beds and adequacy of clinical management. One-hundred and twenty two cases occurred among 9932 deliveries. Massive obstetric haemorrhage (54.2%) and hypertensive disorders of pregnancy (36.9%) were the two main diagnostic groups. Seventy one (58.2%) cases were referred from peripheral centres for obstetric management and 77 (63.1%) were not booked at this hospital for antenatal care. A majority were not ill-looking (92 cases) at the time of admission but turned for the worse in the course of labour. Interventional measures taken in clinical management were considered appropriate in all cases. Delay in instituting treatment was present in 6 cases. Remediable measures were recognised in 15 (12.3%). This study, apart from supplementing mortality audits, demonstrates that high risk obstetric patients can be triaged at the time of admission to labour wards by trained midwives and junior doctors in busy obstetric units without compromising standards of care.

Study site: Obstetric and Gynaecologic Unit in Ipoh Hospital.

Matched MeSH terms: Uterine Hemorrhage/therapy*
Retroperitoneal malignant fibrous histiocytoma causing profuse bleeding per rectum

Sim PH, Pathmanathan R, Jalleh RP

Aust N Z J Surg, 1995 Jan;65(1):68-70.
PMID: 7818432

A case is reported of retroperitoneal malignant fibrous histiocytoma (MFH) invading into the colon, causing fresh bleeding per rectum. It illustrates the difficulty encountered in the pre-operative diagnosis of this condition, especially in a patient with an atypical presentation of profuse lower gastrointestinal bleeding.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology*
An unusual differential diagnosis of myringitis bullosa haemorrhagica

Indudharan R, Dharap AS, Htun YN

Trop Geogr Med, 1995;47(5):227-8.
PMID: 8553451
Matched MeSH terms: Hemorrhage/diagnosis
Fulltext Spontaneous intra-partum rupture of uterine vein--an uncommon cause of intra-abdominal haemorrhage

Kuppuvelumani P, Rachagan SP, Khin MS

Med J Malaysia, 1994 Jun;49(2):185-6.
PMID: 8090103

A rare case of spontaneous rupture of a branch of the uterine vein in a primigravida is discussed. The patient with an uncomplicated pregnancy presented with signs and symptoms suggestive of abruptio placenta with foetal distress. Lower segment Caesarean section was performed. The cause of acute pain was identified to be intra-abdominal bleeding secondary to the rupture of a branch of the uterine vein. The pathophysiology of the problem is discussed.

Matched MeSH terms: Hemorrhage/etiology*
A comparative study of the biological properties of venoms of some old world vipers (subfamily viperinae)

Tan NH, Ponnudurai G

Int. J. Biochem., 1992 Feb;24(2):331-6.
PMID: 1733799

1. The hemorrhagic, procoagulant, anticoagulant, phosphodiesterase, hyaluronidase, alkaline phosphomonoesterase, 5'-nucleotidase, arginine ester hydrolase, phospholipase A, L-amino acid oxidase and protease activities of 30 samples of venoms from nine species (12 taxa) of the old world vipers (Subfamily Viperinae) including snakes from the genera Bitis, Causus, Cerastes, Echis, Eristicophis and Pseudocerastes, were determined and the Sephadex G-75 gel filtration patterns for some of the venoms were also examined. 2. Examination of the biological properties of the venoms of the Viperinae tested indicates the presence of common venom biological characteristics at the various phylogenic levels. 3. Venoms of most species of the Viperinae examined exhibited characteristic biological properties at the species level, and this allows the differentiation of the Viperinae species by differences in their biological properties. 4. Particularly useful for this purpose, are the effects of venom on kaolin-cephalin clotting time of platelet poor rabbit plasma and the Sephadex G-75 gel filtration pattern and arginine ester hydrolase activity of the venom.

Matched MeSH terms: Hemorrhage/chemically induced
Fulltext Fatal haemorrhagic chickenpox complicating nephrotic syndrome

Gangaram HB, Cheong IK

Med J Malaysia, 1993 Dec;48(4):446-8.
PMID: 8183171

We report a 14 year old Indian-Muslim girl who developed a fulminant, disseminated and fatal varicella infection while receiving steroids for nephrotic syndrome. The terminal phase of her illness was complicated by a bleeding dyscrasia and circulatory collapse. Varicella infection in healthy children is a benign disease. However in neonates and immunosuppressed patients it may be severe and often fatal. There are many reports of fatalities occurring in cancer patients receiving chemotherapy, patients on immunosuppressives for asthma, haemolytic anaemia, rheumatic fever, and renal and bone marrow transplantation. Patients with nephrotic syndrome receiving cyclophosphamide treatment are at particular risk of developing severe chickenpox infection. To our knowledge, there has been only one report of fatal chickenpox infection in a child who received steroids for nephrotic syndrome. We report here a case of fatal haemorrhagic chickenpox complicating nephrotic syndrome.

Matched MeSH terms: Hemorrhage/etiology*
Prognostic significance of retinopathy at presentation in adult acute leukemia

Reddy SC, Quah SH, Low HC, Jackson N

Ann Hematol, 1998 Jan;76(1):15-8.
PMID: 9486919

Retinal changes are common in adult acute leukemia patients at presentation, but their prognostic significance is controversial. A 5-year study has been carried out with newly diagnosed acute leukemia patients aged 12-77 years. Seventy-seven cases (49 AML, 28 ALL) were studied prospectively for the presence of intraretinal hemorrhages (IRH), white-centered hemorrhages, cotton-wool spots, and macular hemorrhages. They were treated according to standard chemotherapy protocols, and then achievement of complete remission (CR) and the duration of overall survival (OS) were compared between the groups with and without these different retinal features. No association was found between the presence of any retinal abnormality and CR induction rate, although there was a trend to a lower CR rate among patients with IRH. The median OS of those with IRH was 72 days, compared with 345 days among those without IRH (p=0.002). A WBC at presentation greater than 50x10(9)/l and age greater than 40 years were also associated with shorter OS (p<0.0001 and p=0.0045, respectively). However, after regression analysis, IRH remained statistically significant as a poor prognostic indicator (p=0.01). We conclude that the presence of IRH is an indicator of poor prognosis in acute leukemia.

Matched MeSH terms: Retinal Hemorrhage/complications*
Haemolytic, oedema and haemorrhage inducing activities of tentacular extract of the blubber jellyfish (Catostylus mosaicus)

Azila N, Siao FK, Othman I

Comp Biochem Physiol C Comp Pharmacol Toxicol, 1991;99(1-2):153-6.
PMID: 1675964

1. An extract prepared from the tentacle of the jellyfish (CE), Catostylus mosaicus exhibited haemolytic, oedema and haemorrhage-inducing activities. 2. Acetone treatment of the tentacle extract produced an acetone soluble extract (AE) which showed an increase in specific haemolytic and haemorrhagic activities by 25- and 120-fold respectively; the minimum oedema dose was reduced by 30-fold. 3. The AE caused a rapid onset of oedema in the mouse foot pad. The effect was long-lasting, reaching a maximum in about 30 min after injection and sustained up to 4 hr. 4. Fractionation of the AE on Q-Sepharose gave 4 bound fractions which induced oedema and haemorrhage; however only 3 of the fractions exhibited haemolytic activity.

Matched MeSH terms: Hemorrhage/chemically induced*
Bleeding manifestations of dengue haemorrhagic fever in Malaysia

George R, Duraisamy G

Acta Trop, 1981 Mar;38(1):71-8.
PMID: 6111919

Analysis of the bleeding manifestations of 130 cases of dengue haemorrhagic fever admitted into the Children's ward of the General Hospital, Kuala Lumpur from May 1973 to September 1978 has been done. Petechial skin rash, epistaxis and gum bleeding were seen most commonly in mild and moderately severe cases. However, blood stained gastric aspirates, and severe haematemesis were seen in severe or very severe cases. Though with better vector control and preventive measures, a marked reduction in the incidence of the cases has been noted, severe cases were seen with symptoms of shock and gastrointestinal bleeding. These symptoms carried a bad prognosis. Among 15 children that died 10 had gastrointestinal bleeding and 2 had a disseminated intravascular coagulation defect. Lymphocytosis with atypical lymphocytes, low platelet count, low reticulocyte count and raised packed cell volume were the main haematological features seen in all these cases. All these features reverted to normal within a week. Mild evidence of disseminated intravascular coagulation was seen in a number of cases, but severe features were seen only in four. Two cases improved as a result of heparin therapy.

Matched MeSH terms: Hemorrhage/etiology*
Fulltext Coital injuries: a study of three cases

Narkunam R, Raman S, Kulenthran A, Sinnathuray TA

Med J Malaysia, 1984 Mar;39(1):78-81.
PMID: 6513845

This study reviews experiences in the management of three cases of lacerations of the vagina following coitus. A brief review of the recent literature is made. Although the extent of injuries can be very variable, the principles of management consist of prompt
resuscitation and arrest of haemorrhage, appropriate surgical repair under general anaesthesia, and systemic or local antibiotic therapy to combat infection. Avoidance of vigorous or abnormal coital practices, especially in single women, in the immediate postpartum period, and in postmenopausal women, can help to reduce the frequency and severity of such injuries.

Matched MeSH terms: Uterine Hemorrhage/etiology*
Fulltext Peptic ulcer disease in Kelantan: an underdiagnosed condition?

Raj SM

Med J Malaysia, 1991 Jun;46(2):183-6.
PMID: 1839424

A review of the records at a teaching hospital in Kelantan revealed that 175 new cases of peptic ulcer disease were diagnosed endoscopically over a period of 5 years. The ratio of duodenal to gastric ulcers was 2:1. Male patients outnumbered females by 2.7:1. There was a disproportionately high number of Chinese patients. A striking observation was that an unusually large proportion (45%) of patients had presented with acute gastrointestinal bleeding. The implication is that peptic ulcer disease in this region may be underdetected; the diagnosis often coming to light only after a serious complication has supervened.

Matched MeSH terms: Gastrointestinal Hemorrhage/etiology
Age of onset of symptoms in duodenal and gastric ulcer

Kang JY

Gut, 1990 Aug;31(8):854-7.
PMID: 2387504

The influence of the age of onset of symptoms on various clinical features of peptic ulcer was studied in a personal series of 492 patients (duodenal ulcer 363, gastric ulcer 98, combined gastric and duodenal ulcer 31). Duodenal ulcer patients whose age of onset of symptoms was within the first three decades (n = 166) were more likely to be men (77%) and to have a positive family history of dyspepsia (45%) and a history of haemorrhage (46%) when compared with late onset patients (n = 197, men 57%, positive family history 23%, history of haemorrhage 36%). Early onset duodenal ulcer patients also secreted more gastric acid than late onset patients. In contrast, while early onset gastric ulcer patients were more likely to be men, when compared to late onset patients, the two groups were similar in their family history of dyspepsia, their history of haemorrhage, and their gastric acid output. The age of onset of Malay duodenal ulcer patients (mean (SD) 43.6 (16.0] was higher than those for Chinese patients (33.7 (16.1].

Matched MeSH terms: Peptic Ulcer Hemorrhage/epidemiology
Caesarean hysterectomy--a review of 21 cases in the University Hospital, Kuala Lumpur

Rachagan SP, Sivanesaratnam V

Eur J Obstet Gynecol Reprod Biol, 1984 Jan;16(5):321-6.
PMID: 6608460

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.

Matched MeSH terms: Postpartum Hemorrhage/surgery

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