The experiences gained through the use of pectoralis major myocutaneous flap in reconstructive head and neck cancer surgery in 15 cases is presented. It is our method choice for a one-stage reconstruction in head and neck The flap has survived in 14 out of 15 cases. It has definite advantages over other flaps used in head and neck reconstruction.
The severity of pulmonary aspiration depends mainly on the acidity of the aspirate. Mist magnesium trisilicate (MMT) has been used for many years at the maternity unit in General Hospital, Kuala Lumpur, to neutralise the acidic gastric contents in all obstetric patients requiring caesarian section. This preliminary study shows that a single dose of 15 mls of MMT before general anaesthesia raises the intragastric pH to above the critical level of 2.5 in 80% of the patients. Recently there have been doubts over the protective role of MMT. Sodium citrate which is the other antacid available may be a better alternative.
Seven infants with birth weights less than lS00g received total parenteral nutrition for seven to 16 days through the peripheral route, commencing within the first 24 hours of life. Excessive weight loss was prevented and the infants showed significant weight gain. The time required to regain the initial birth weight showed an improvement over that expected in conventionally managed infants. Metabolic and septic complications were minimal and easily manageable. The results demonstrate that the technique, when properly used, warrants consideration in feeding low birth weight infants incapable of tolerating enteral feeding.
Sexually deviant behaviour is a fairly common phenomenon but because it is socially embarassing, a few cases come forward for consultation and treatment on a voluntary basis. Most cases are referred by the law courts. Two such cases, one of exhibitionism and the other offetishism, were referred to the University Hospital, Kuala Lumpur in 1982. Their development histories were elaborated. A third case of sexual sadism came voluntarily for help out defaulted after the initial session. A review on the current western concepts on sexual deviation is included in the text. It is concluded that although it is generally thought that neurological conditions give rise to deviant sexual behaviour, this assumption should not be arrived at hastily, as many cases of organic mental disorders do not exhibit deviant sexual
behaviour.
Features of the typical ameloblastoma of the mandible are outlined. Three cases managed by conservative surgical treatment maintaining the continuity of the mandible are described. The factors taken into consideration when instituting this method of treatment are discussed. Results obtained are encouraging.
The efficacy of xylocaine topical anaesthetic and a placebo in reducing intraoral injection pain were tested in 72 patients. The topical agent was found to be very effective in reducing such pain and the authors recommend its use prior to intraoral injections for the benefit of the patient.
Psychiatric consultation in schools is not a new concept in the Western Countries but it is so in Malaysia owing to the lack ofa sufficient number of trained psychiatrists available locally. The aim of consultation is to help the school authorities to understand and to solve emotional and behaviourial problems of school children. The authors have begun a study project, on a voluntary basis, on the psychiatric problems of the school children of a secondary school in Kuala Lumpur. This was possible with the cooperation between the Department of Education, Kuala Lumpur, the Department of Social Welfare, Federal Territory and the Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur. The authors used two methods to gather data, namely through individual evaluation of the referred students (a total of 23 students having been interviewed) and through the holding of group therapy sessions with the consultee as the cotherapist. The authors found that minor behaviourial problems such as inattentiveness, talking, eating and sleeping in the classrooms constituted the majority of the reasons for referral. This was followed by problems concerned with poor academic performance, including the quality of class work. Major problems such as theft, extortion and gangsterism and personal emotional problems such as interpersonal relationship problems, boyfriend/girfriend problems and sexual problems were also encountered. Female pupils appeared to be more forthcoming in discussing their problems. The project has resulted in the school gradually adopting the guidance rather than the purely disclplinary concept in understanding the pupils' problems and their maladjustment behaviour in many cases. Joint efforts by psychiatrists, psychologists, professional social workers and school health personnel should be invested in this important area of school education.
One hundred and fifty patients with urothelial tumours were reviewed. They form the majority of patients with bladder cancer referred to the Institute of Urology over the past three years. From the study it becomes very apparent that the majority of patients are seen late in the course of their disease. The results of treatment of patients with early lesions have been satisfactory but the patients with late invasive lesions have very poor prognosis. A plea is made that one be more aware of this condition and that symptoms of haematuria and urinary tract infections should have a full urological assessment early.
A retrospective report (1970-1980) on patients (non-head injuries and head-injuries) admitted with cerebral ischaemia into the intensive therapy unit is presented. The principles of management to reduce and control intracranial pressure are outlined. Since 1978 continuous intravenous infusion with Althesin has been used instead of barbiturates in the regime. Mortality rate fell from 83.7 percent (1970-1977) to 43.7 percent (1978-1980) for non head injury patients and from 72.1 percent (1970-1977) to 45.6 percent (1978-1980) in the head injured group, the differences between the periods being statistically significant. The possible influencing factors are mentioned. The quality of salvage and survival requires investigation.
Two patients with ascending aortic aneurysms due to cystic medical necrosis are described. One of them was phenotypically normal while the other had features of Marfan's syndrome. Both were disabled by dyspnoea and angina which required corrective surgery.
Two outbreaks involving 31 persons with jaundice are described. All had originally been diagnosed as having viral hepatitis. But subsequent investigations showed that all had been exposed to chloroform at work. Toxic jaundice from chemical exposure presents a similar clinical picture to that of viral hepatitis, but fever appears to be uncommon. Doctors who look after workers should be familiar with the type of work and health hazards of their patients. A knowledge of occupational medicine and epidemiology would enable doctors to help in detecting and preventing
occupational disease.
Enterotoxin production by strains of Staphylococcus aureus isolated from foods unconnected with outbreaks offood poisoning was investigated. Twenty-three percent of 217 strains examined produced enterotoxins A, B, C, D or E. Enterotoxin C was found to occur most frequently. Enterotoxin A was not detected alone from any of the strains examined, but occurred together with other enterotoxins. The overall number of strains isolated from raw foods which produced one or more enterotoxins was higher than that for cooked foods. Antibiotic sensitivities were unrelated to enterotoxin production and no correlation could be found between methicillin resistance and enterotoxigenicity.
The authors, a psychiatrist and a clinical psychologist, have successfully treated two cases of phobic neurosis by simple behaviour therapy consisting of Jacobson's muscle relaxation technique and systemic desensitisation, at the University Hospital, Kuala Lumpur. The two patients, who were literally housebound because of the unpleasant symptoms of their illness, were able to mobilise themselves again following therapy. The authors feel that general practitioners with some basic training in these methods will be able to bring relief to such afflicted patients. Using the same technique, other conditions such as insomnia, alcoholism and sexual deviations can also be treated.
Thanatophoric dwarfism is a severe form of neonatal shortlimbed skeletal dysplasia. Most infants are stillborn or die soon after birth. This disorder has well defined radiological features which distinguish it from the other forms of neonatal dwarfism. We report two cases where short limbs were detected on sonography and a diagnosis was made on antenatal radiographs and fetography.
Carcinoma of the buccal mucosa is the commonest intra-oral malignancy seen in Malaysia. The purpose of this paper is to present 12 patients with carcinoma of the buccal mucosa who were seen by the authors between January 1981 to September 1981. The principal problems are those of late presentation and treatment, these aspects are illustrated, with a view of early return to normal life.
Genital discharge from patients unth. smear positive gonorrhoea was transported from the clinic to the laboratory in. Stuart's transport medium (Oxoid CM 111). Within. six hours of transit time the recovery rate of gonococci was 94%. When compared with "bedside" inoculation onto Modified Thayer Martin medium, there was no significant difference in recovery rates up to 6 hours of transportation in Stuart's transport medium, However, the rate of isolation of gonococci was significantly reduced after 20 to 30 hours of transportation. It is concluded that Stuart's transport medium is an acceptable transport medium for specimens containing gonococci when specimens reach the laboratory within 6 hours of collection.
Enterobacteriaceae isolated from clinical sources were examined for antibiotic resistance and the ability to transfer resistance to Escherichia coli. Twenty-nine out of 80 strains tested transferred part or all oftheir resistance genes. The strains carrying R plasmids included the genera Escherichia, Klebsiella, Salmonella, Enterobacter, Proteus, Providencia and Citrobacter. These results indicate that R plasmids possibly play a major role in the emergence of antibiotic resistance among clinical isolates of Enterobacteriaceae.
The IgM-globulin levels were determined for 5,167 cord-sera of apparently normal infants and 281 sera of defective infants aged 4 months and younger. The significant level for IgM-globulin in neonates was found to be 20 mgm/dl (2 SD above mean of the normal) above which the level was regarded as abnormally raised. Significant levels of IgM-globulin were found in 0.2% (11/5, 167) ofnormal neonates and in 40.6% (114/281) of defective infants which is more than 200 times the normal value. Combining the normal and abnormal rates, an overall figure of 23 intrauterine infections per 1,000 live births were obtained for Malaysia. The advantages and disadvantages of the use of serum IgM-globulin elevations for the diagnosis of intrauterine infections were discussed.