In a two year period between 1985 and 1986, eight children presented with impacted blunt foreign bodies in the oesophagus were successfully treated by removal using a Foley catheter without anaesthesia. There were no complications. All patients were discharged well after one or two days in hospital. The technique is safe, rapid and easy to perform.
Autoantibodies to the three extractable nuclear antigens (ENA), Anti-SSA (Ro), Anti-Sm, Anti-RNP and antinuclear antibodies were determined in 150 patients with SLE. Seventy patients (46.7%) had Anti-SSA (Ro), 40 (26.7%) Anti-Sm and 25 (16.7%) Anti-RNP antibodies. Ninety four percent patients had a positive Fluorescent anti-nuclear antibody (FANA) test. The commonest FANA pattern is the speckled pattern. Subclinical keratoconjunctivitis sicca (KCS) was present in 60% patients. No correlation could be demonstrated between the presence of ENA autoantibodies and the clinical features of patients.
A survey showed only 27% of our house-officers know how to intubate. Ninety-two percent however recognise the alternative to intubation. On the whole, knowledge centering around intubation is generally lacking.
Eighty-six children diagnosed as child abuse and/or neglect were admitted to the Paediatric wards of the General Hospital, Kuala Lumpur during 1985 and 1986. Of these cases, 62 were of physical abuse, six of sexual abuse, one case of both physical and sexual abuse and 17 of neglect. There were 25 boys and 61 girls. Thirty-four of these children were Malays, 16 Chinese, 26 Indians, three mixed and seven illegal immigrants. Twenty-one were below the age of one year, 24 from one to four years, 25 from five to nine years and 16 were ten years and above. The abusers were mainly close members of the family. Of these children, 24 were sent back to their parents and 11 to their relatives home. Twenty-seven were taken into care by the Ministry of Social Welfare and the remaining seven children who were illegal immigrants, were deported with their parents. Only one child was successfully fostered. Eleven children were taken away from the hospital by their parents or guardians without the knowledge of the health staff. There were five deaths in the series.
A case of Waldenstrom's macroglobulinemia with classical findings of IgM paraproteinaemia and a typical lymphoplasmacytic marrow infiltrate is reported and the treatment of this patient outlined.
Percutaneous insertion of central venous catheter (CVC) is a valuable procedure in managing critically ill patients. However, placement of CVC is not without its complications. The author reports a case in which a CVC was inserted into the right pleural cavity which was not detected by the usual clinical methods of confirming catheter placement and an antero-posterior (A-P) chest x-ray.
The 'Priming principle' applied to non-depolarizing muscle relaxant atracurium was studied in 60 patients. This was a double blind study. The conditions observed for intubation were graded and the efficacy of priming dose of atracurium for shortening the onset time of intubation was studied. The patients were of ASA classification I and II and received standard premedication. The purpose of the study was to use the priming dose of atracurium to shorten the onset time of intubating dose of atracurium. This would be desirable in conditions requiring rapid intubation and in situations when the depolarizing muscle relaxant suxamethonium is contra-indicated. The results were statistically significant.
A case of carotid body tumour is presented. Pathology, diagnostic investigations, modalities of treatment and prognosis are discussed. With greater awareness of this condition and improvement in diagnostic investigations and surgical techniques, the outlook in managing this condition should be better.
Mesenteric venous thrombosis has been described to occur in cases where there has been no apparent cause. The diagnosis is usually delayed because the signs and symptoms are non-specific. A case of primary mesenteric venous thrombosis is reported below. Its presentation and pathology are discussed. Treatment is surgery with resection of gangrenous bowel and primary anastomosis. Post-operative anticoagulation is advocated.
A six-month survey of 828 patients admitted to the Coronary Care Unit (CCU) of the General Hospital, Kuala Lumpur was carried out to ascertain whether the smoking habits of the patients predisposed them to definite coronary events and its immediate outcome i.e. early mortality (within seven days). The various ethnic groups were also screened to determine if they were at increased risk to coronary events in relation to other known risk factors. Three hundred and eleven patients - 239 males, and 72 females - had confirmed acute myocardial infarctions of whom 190 were smokers (172 males, and 18 females). Sixty-nine infarct patients died within the first seven days post-Ml: 35 were smokers (50.7%). Two-hundred and eighty other patients had non-infarct coronary events. Of these, 167 were smokers. In contrast, only 99 out of 237 patients admitted for non-coronary events, were smokers. It thus appeared that patients admitted to the CCU for suspected cardiac events had a greater incidence of confirmed acute myocardial infarction or acute coronary events if they were smokers (p < 0.001). Mortality from these coronary events was not seen to increase among smokers in this population sample. Women who smoked as a whole, were not found to be at increased risk to coronary events, but women smokers 60 years and older were shown to be at increased risk to developing confirmed coronary events (p < 0.01).
In Malaysia, the elderly are still a relatively neglected group of people in that little priority is given to the important health issues associated with an aging population. This paper examines some of the relevant findings obtained during a survey which was carried out in 1984/1985. These findings have serious policy implications concerning family support, work, income, retirement, community involvement, social network, transport, and housing as pertaining to the elderly. There is an urgent need, as the population ages and social changes occur in society, for health planners, politicians and policy-makers to scrutinise the existing policies and develop new policies so as to retain those traditional practices that support, improve and maintain the psychological and social well-being of the elderly; and to develop new policies and programmes thus promoting a better lease of life for this small but important group to whom we owe so much.
The first two cases of human muscular sarcocystosis are reported from East Malaysia, in Sabalt and Sarawak respectively. Sarcocysts were seen iin biopsied specimen from the nasopharynx of both patients who had carcinoma of the nasopharynx. The measurements and appearances of the cysts and the zoites within the cysts were compared with the human cases of sarcocystosis previously reported in West Malaysia. Zoonotic and other aspects of these cases of East Malaysian sarcocystosis are discussed.
A rare complication of per rectal extrusion of a ventricule peritoneal shunt catheter occuring in a four-month old Chinese baby boy with hydrocephalus is described. Perforation of the bowel by the shunt occurred without any peritonitis or retrograde infection of the shunt system. Its pathogenesis and diagnosis are discussed.
Over a period of nine years, from June 1976 through May 1985, 18 cases of ruptured sinus of Valsalva aneurysms were seen at the University Hospital, Kuala Lumpur (UK KL). Seven of these cases were treated surgically. The majority of patients were males, with a mean age of 26.6 years. All cases were symptomatic. The site of aneurysm was the right coronary sinus in five patients and the non-coronary sinus in two patients. All aneurysms ruptured into the right ventricle. The fistula was closed via a transaortic approach. In addition, repair of the right heart chamber was necessary in six patients. There were no deaths. Clinically significant morbidity included aortic regurgitation in one patient and residual fistula requiring reoperation in another. The long term follow-up at two years was excellent.
Forty-eight patients treated surgically for chronic subdural hematoma in General Hospital Kuala Lumpur were studied retrospectively. The clinical presentations were insidious and nonspecific. A high clinical index of suspicion for this disease is required. Diagnosis is confirmed by CAT Scan of the brain with or without cerebralangiography. Treatment consists or burr-holes and drainage
This study analyses retrospectively the results of sixteen acute dislocations of the knee at the University Hospital, Kuala Lumpur from 1980 to 1985. The average follow-up was 3.5 years. There were seven posterior, six anterior, one lateral and two postero-lateral dislocations. All were due to motor vehicle accidents except one. There were four patients with popliteal artery injury and two patients with peroneal nerve injury; three required amputations due to late detection. All the peroneal nerve palsies were permanent. The results of surgical treatment appear to be better than conservative management of acute dislocation of the knee.
226 peritoneal dialyses were performed on 100 patients. 28 patients presented with acute renal failure. Uraemia was the most frequent indication for dialysis. Peritonitis was an important complication and Acinetobacter species accounted for 51.5% of the positive cultures. Other complications included poor dialysate drainage and hypokalemia. Mortality was mainly due to causes unrelated to peritoneal dialysis.
This is a review of 20 cases of ameloblastomas diagnosed and treated at the Dental Faculty, University of Malaya, Kuala Lumpur. The clinical features, histological features and treatment methods are presented. Two basic clinical types namely the conventional (solid/multicystic) and unicystic ameloblastomas showed different recurrence rates. Discrepancies between the recurrent rates in this study for conventional ameloblastoma and for unicystic ameloblastoma and those of other reports are discussed. A brief discussion on the treatment modalities used is also presented.