A term, Malay male neonate, delivered by spontaneous vertex delivery, was found to have a huge carvenous hemangioma on the anterior chest wall. He developed respiratory failure on the second day of life. Having considered the various options possible, an emergency surgical excision was carried outat the age of 57 hours. The patient recovered after a stormy post-operative period.
Delusions are common among psychiatric patients. Delusions of passion can be very systematised and, at the same time, incredible. The delusions can remain fixed for a long time and treatment is usually not satisfactory. One of the exotic and rare psychiatric conditions is de Clerarnbault's Syndrome and the main feature is a pure erotomania. This condition defies satisfactory classification in the current ICD-IX and DSM-III, and remains as one of the most difficult to treat and troublesome syndromes. Two patients who developed the symptoms of erotomania were treated by the University Hospital, Kuala Lumpur in 1982-1983. One had the primary erotomania of de Clerambaults syndrome while the other suffered from erotomania as a secondary symptom which was part of the symptomatology of her primary illness of schizophrenia. Their case histories and the current western concepts on erotomania were described.
During the period 1971-1982, 57 salmonella strains other than S. typhi and S. paratyphi were isolated from sites other than stools and blood. Cerebrospinal fluid was the commonest specimen followed by urine and pus. The commonest serotypes of the 22 encountered were S. typhimurium and S. enteritidis. Twenty-four of the 57 patients were children under one year of age. These findings highlight the need to remember the unusual manifestation of salmonellosis in differential diagnoses.
The incidence of Campylobacter jejuni in patients with and without diarrhoea was studied in Kuala Lumpur, Malaysia. C. jejuni was recovered from 3.8% and 4.3% of diarrhoeal stools of children and adults, respectively. From the patients without diarrhoea, the relative isolation rates for children and adults were 2.6% and 0%, respectively. Dual infections occurred in two children, with Salmonella and enteropathogenic Escherichia coli being the other enteric pathogen in each case. Cary-Blair medium was found to be an effective transport medium in recovering C. jejuni. Campylobacter enteritis occurred in patients of various age groups, indicating that this organism should be sought routinely by diagnostic laboratories in faecal specimens from patients with diarrhoea.
A case of A. V. fistula of the superior thyroid vessels following thyroidectomy is reported. Though the standard treatment of such a fistula is ligation and excision, a more simple Iigation and division of the superior thyroid artery is adequate for reasons mention. The demonstration of the feeding vessel by angiogram has to be accurate.
This paper presents a case report of a primary lymphoma of the appendix as the underlying cause of acute appendicitis. As in previous reported cases, diagnosis can only be made intraoperatively followed by a proven histopathological picture as they present with an acute surgical abdomen.
Toxoplasmosis is a parasitic infection of worldwide distribution. It is caused by an obligate intracellular parasite, Toxoplasma gondii. The commonest form of this disease is the acquired simple lymphadenopathy. Such a case is described and the clinicopathological significance of the disease is discussed.
Two children with Juvenile Rheumatoid Arthritis (JRA) and severe growth suppression from corticosteroid therapy are described. Prolonged 'tailing-off' of steroids occurred during outpatients follow-up and this may be related to the high turnover of doctors involved. Suggestions for improving such follow-ups and caution against the continuous use of steroids are made.
Study site: Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
Four cases of tropical myositis seen over a period of four months at the Penang General Hospital are reported here. All were young local residents in whom large amounts of pus were found deep within skeletal muscles without an obvious aetiological factor.
Ultrasound measurement of ocular dimension is the chosen method for assessing axial length when determining dioptric power for intraocular lens. From the current results of 30 cases studied, the mean axial length ranges from 22 to 23 mm. Despite the limitation of the accuracy of the ultrasonic measurements with the 7.5 mHz transducer, the power of intraocular lens can. be determined satisfactorily in accordance with the knowledge of keratometric reading. Hence, high refractive errors could be avoided post-operatively.
The relationship between locus of control and reaction to illness is empirically examined in a group of patients on haemodialysis for chronic renal failure. Results of the study suggest that patients who perceive themselves as having personal control over life events tend to have stronger feelings that their illness has made them dependent on others. There is also a greater tendency for them to exhibit more information seeking behaviour, and to adopt an active, problem-solving and intellectual approach to cope with their chronic renal failure. Relevance of the findings and implication for treatment outcome are discussed.
A case is presented to illustrate the difficulties
encountered in the clinical diagnosis of an intraocular mass. The fundus was not visible ophthalmoscopically because of opaque media. The anterior surface of the iris showed three discrete hyperpigmented nodular patches. Ultrasound showed an intraocular mass occupying half the posterior segment. The eye did not have useful vision and was enucleated after a clinical diagnosis of malignant melanoma of the choroid was made. The eye did not contain a melanoma but an organised blood clot after an extensive vitreous haemorrhage because of systemic hypertension.
179 heterosexuals, selected for VDRL testing on the basis of a history of involvement in promiscuous sexual activity, mainly prostitution, had their serum also tested for hepatitis B infection markers, HBsAg, HBeAg and anti-HBe. 51 samples (29%) were found to be positive for at least one of the three markers, at levels higher than the already high levels in voluntary random blood donors in Malaysia.
A survey to assess the degree of occupational and physical rehabilitation was conducted on patients treated on chronic haemodialysis, using the semiquantitative Karnovsky scale. The survey revealed that over 90% of patients achieved good rehabilitation and returned to employment or to household duties. Chronic haemodialysis is effective in prolonging life and most patients were rehabilitated with useful levels of physical activity.
Studies made on aqueous root extract of Selayak Hitam, a plant alleged to possess abortifacient activity in pregnant mothers established that the extract is teratogenic and did in fact cause abortion in mice. It was also observed that the aqueous root extract is relatively toxic as judged by the number of deaths occuring following administration of the extract. The mechanism by which abortion is brought about is unknown but it is possible that the abortifacient effect is due to the induced teratogenic activity, brought about by the extract.
Long-term ventilatory support of a child with bronchopulmonary dysplasia is described. Dedicated nursing care and emotional support of child and family were two important factors in the management of the child in intensive care, and in the weaning of the child from the ventilator.