The left atrial myxoma is important not only because of its relative frequency and diagnostic difficulty but because it can be successfully removed by surgery. However, if untreated, it invariably leads to death. We report three cases seen at the Cardiology Department, General Hospital, Kuala Lumpur in 1985.
One hundred and forty-one Penans from three longhouses along the Melinau and Terawan Rivers, Baram, Sarawak were examined. The number of decayed, missing and filled teeth was determined for each subject. The number of Penans who wore dentures was noted likewise the number of Penans who brush their teeth was recorded. The relationship between these findings and their possible causes are discussed.
An alarm about suspected toxic gas leakage was raised in a primary school. All the students were evacuated by the staff and the community to a district hospital in Teluk Intan, Perak, about 8 km from the school. Sixty-four primary students from the school, four secondary school students and a student’s mother, who was near the school were all examined by a team of medical officers: Perceptions and records of the incidence from the students, staff and medical officers were recorded and examined by the author who visited the school and the hospital after the incidence. Psychosomatic symptoms related to anxiety attack were predominant There was no evidence of any gas leak. Symptomatic management was given by the medical officers. The psychogenic aetiology of the subsequent physical symptoms and behaviour, and the difference from epidemic hysteria are discussed.
A retrospective study of 34 patients with supracondylar-condylar fractures of the femur admitted to the Alexandra Hospital, Singapore, from January 1979 to December 1983 was carried out. These fractures were surgically treated by AO principles and fixation, and the surgery performed mainly by the two authors. Using strict criteria adopted from Schatzker of Toronto, 1 it was found that 62% of patients had excellent/ good results. The importance of treating supracondylar-condylar fractures by AO principles and fixation is emphasised.
The purpose of this study was to assess M-mode echocardiographic criteria for pulmonary artery hypertension in patients with intracardiac shunts, and to observe any signs not previously described.
Forty-seven consecutive cardiac cathetherised patients with routine M-mode echocardiogram done were reviewed. Twenty-six patients had atrial septal defect, nine had ventricular septal defect (VSD), four had patent ductus arteriosus (PDA), five had Eisenmenger syndrome and three had combined VSD and PDA.
Fifteen of 20 patients with pulmonary artery mean pressure (PAMP) of more than 50 mmHg demonstrated diminished a-dip (p < 0.001), reduced e-f slope (p < 0.01) and increased b-e slope to > 380 mm/sec (p < 0.01). The presence of systolic flutter or mid-systolic notch, or both was not observed in patients with normal PAMP, but was noted in all of the 20 patients with raised pressure(> 50 mmHg).
This study confirms the limitation of M-mode echocardiographic features in the evaluation of pulmonary artery hypertension in patients with intracardiac shunt, though clinically useful.
Fractured penis has traumatic consequenoes on the patient as both his manhood and procreation ability are threatened. 2 cases of fractured penis successfully treated at the Armed Forces Hospital, Terendak, Melaka by a combination of surgical intervention and splintage are reported and the management discussed.
Infantile or developmental coxa vara is a relatively infrequent localised dysplasia of unknown etiology which usually presents in the second or third year of life soon after the child begins walking. The clinical and radiological picture is usually characteristic especially when seen early. Early surgery leads to a satisfactory outcome. However, difficulty arises in diagnosis and treatment when patients present late, three cases diagnosed in adolescence at the University Hospital, Kuala Lumpur over the last 10 years are presented to increase awareness of this condition, which may be underdiagnosed, and the difficulties in diagnosis and treatment with late presentation are stressed.
A case of acute appendicitis occurring in a 10- month-old infant is reported. The difficulties of an early preoperative diagnosis are highlighted. Perforation has usually occurred on presentation. However, prognosis may not necessarily be poor if active measures are instituted soon after perforation. The importance of active and aggressive preoperative resuscitation with fluids and electrolyte and intravenous antibiotics is stressed.
A series of 18 cases of tuberculous encephalopathy (TBE) in children studied between June 1983 and October 1984 at Queen Elizabeth Hospital, Kota Kinabalu is presented. The data suggest that: the incidence is not as rare as previously thought; the occurrence of TBE is related to the absence of BCG vaccination; the presentation is often late; laboratory data, although helpful is not often confirmatory; early treatment is the key to better outcome; the clinical picture should outweigh laboratory diagnosis in the initial assessment and management.
A study was carried out at the University Hospital, Kuala Lumpur, Malaysia to determine the age-specific prevalence of measles infection by serology and the age specific - seroconversion rates following measles vaccination. The results show that the percentage of children with passively acquired measles antibodies decreased with increasing age fill three to five months of age. From 12 months of age, the percentage of positivity increased sharply due probably to natural infection. The geometric mean antibody titre was low at birth, but from six months it started to increase. These results indicate that measles infection is common in Malaysia and a small number of children began to acquire natural measles infection from six to eight months of age; however the peak age for the acquisition of measles infection was from 12 months to five years of age. Seroconversion rates following vaccination from nine months of age, ranged from 94-99%. However, the rates and the geometric mean titre were higher among those vaccinated at 11 months of age or older compared with those vaccinated at nine or ten months of age. Based on the above results, it is concluded that the optimum age for measles immunization in Malaysia should be 11 months.
Pseudoseizures, weakness of limbs, elective mutism, dystonia and behaviour problems were the presenting symptoms in three children from three different families with crises superimposed on chronic marital and familial stresses. Lack of open communication among parents and children contribute to the use of physical symptoms as an expression of emotional conflicts. Psychotherapeutic management includes individual and family counselling which begin with obtaining a history of psychosocial background and recent stresses. The families, in addition to seeking modern medical intervention, proceeded with their own religious, cultural and social management.
The right heart pressures and saturations at different sites were measured in 87 normal individuals over a 16-year period during heart cardiac catheterisation. The right heart pressure measurements were comparable with normal values reported in Caucasian subjects. However, the total pulmonary vascular resistance and systemic vascular resistance were significantly different, though the pulmonary vascular resistance was comparable.
A morbidity survey was carried out on a sample of eight longhouses in the Entabai area of the Sixth Division, Sarawak. Of the 645 respondents interviewed, only 148 (22.9%) had experienced at least one spell of illness during the one month prior to the survey.A total of 161 spells of illness was reported, giving a rate of three spells per person per year for the community. Most of the complaints were mild in nature, with fever and aches being the commonest reported. About two thirds of the illnesses were seen by the village aide or at the klinik desa, while the remaining preferred to be treated by the manang. A sub-sample of 49 heads of household were interviewed on their views of the causation, prevention and spread offive common conditions. About 14-43% of the respondents had no knowledge of the causes of fever, cough, diarrhoea or worms. Among those who mentioned some causative factors, only a portion had correct concepts of the various aspects of diseases. Food taboos associated with the five conditions were not too numerous or extensive enough to affect dietary intakes. However, this is not so during the post-partum period where the mother is not allowed to eat many vegetables and meat which are common items in their everyday diets.
We report a case of systemic lupus erythematosus complicated by transverse myelopathy and hyperphagia. To our knowledge the latter has not been reported before.
A case of Acute Post Exertional Anterior Compartment Syndrome of the leg, seen five days after the onset of symptoms is presented. Decompression with delayed closure was done. There was only sensory recovery. However functional recovery at one year was good. Acute Post Exertional Compartment Syndrome cases are diagnosed late due to the lack of awareness, the paucity of radiological features, and the presence of intact peripheral pulses. A review of the literature revealed no previous documentation from South-East Asia.
Parkinsonian syndrome attributed to craniocerebral trauma is rare. Two young adult males developed Parkinsonism following severe head injury. The clinical features and response to therapy are described.
In this project, a retrospective study regarding the anaesthetic techniques, complications and the relevant monitoring aids needed during the procedure, is made from analysis of the 100 available anaesthetic records of cases done during the five years at the Urology Department, General Hospital, Kuala Lumpur. The total number of cases done during 1979-1984 was 112 but 12 anaesthetic record sheets were missing. The patients requiring renal transplant operation were representative of the end-stage chronic renal failure population of Malaysia with the usual high incidence of cardiovascular and biochemical abnormalities. Except for two cases of epidural anaesthesia, all the other patients received general anaesthesia. Induction was with intravenous barbiturate followed by muscle relaxant, neurolept or narcotic and halothane supplement for maintenance. There were no intraoperative or postoperative deaths due to anaesthetic complications. There were five cases of anaesthetic morbidity of which three cases had inadequate reversal of neuromuscular blocking agents and required postoperative ventilation and two cases had poor respiratory effort and required naloxone supplement. Less serious complications such as allergic manifestations were seen in three cases with use of the new muscle relaxant atracurium. The conclusion was that general anaesthesia using thiopentone for induction, pancuronium bromide for intubation and maintenance of muscle relaxation and neurolept fentanyl/droperidol and halothane supplement, all in doses tailored to the requirements ofa renal failure patient, is a suitable technique of anaesthesia for renal transplant operation. Atracurium, the new muscle relaxant, seems to be a favourable alternative to pancuronium bromide. However, as only five cases in our study received atracurium, further studies would have to be done to support it.
22 patients with proven hydatidiform molar pregnancy were subjected to whole lung tomography. By this technique, lung metastases were detected in four patients when plain chest radiographs had shown no secondaries. In a fifth patient additional nodules not observed on the plain radiographs were seen. The usefulness of this procedure as an adjunct to existing methods of following up of patients with metastatic trophoblastic disease is discussed.