About two-thirds (67.6%) of 142 Ibans (from birth to 90 years of age) from 26 house-holds in a longhouse in Nanga Atoi in the Second Division of Sarawak were infected with intestinal parasites. The more common helmintic infections were hookworms (47.2%) and Trichuris trichiura (43.0%). Intestinal protozoan infections were less common. Single helmintic infections were more common than multiple infections and the commonest type of multiple infections was Trichuris mixed with hookworms. Malaria and filariasis were not reported among these inhabitants surveyed.
An 84 year old man who presented with Stokes Adams syncope with exertion was found to have complete heart block on walking with reversion to sinus rhythm on recovery. The resting ECG showed evidence of ischemic heart disease with old anteroseptal and old inferior infarction but there was no recent myocardial infarction as shown by normal cardiac enzymes levels. The probable explanation for the mechanism and causation of the transient A-V block is described.
Fifty seven strains of Pseudomonas pseudomallei were tested for in vitro susceptibility to 15 antimicrobial agents. Amongst the generally recommended antibiotics for therapy of melioidosis, only 86%, 84% and 58% of the strains were found to be sensitive to trimethoprim-sulphamethoxazole, chloramphenicol and tetracycline respectively. Of the newer B-Iactams, in descending order of activity were, ceftazidime, ceftriaxone, cefotaxime, cefoperazone and cefuroxime. But on a weight for weight basis, ceftazidime was the most active agent and as such, may be considered in the therapy of acute septicaemic melioidosis."
Thirteen cases of late haemorrhagic disease of infancy due to vitamin K deficiency presenting with intracranial haemorrhage were seen over a three - year period from 1984 to 1986. The clinical picture was fairly typical; a short history of being unwell (poor feeding, vomiting, irritability, high pitched cry, fits) and physical findings of pallor, a normal body temperature, impairment of consciousness, abnormal respiration and a very tense anterior fontanelle. Vitamin K deficiency was implicated by the prolonged prothrombin time which rapidly returned to normal with vitamin K injection. The outcome was poor. Possible factors giving rise to vitamin K deficiency are discussed. The author suggests the introduction of the giving of vitamin K to all new-borns.
Myelodysplastic syndromes appear to be a rare group of blood disorders in Malaysia. It usually affects the elderly and some of the cases were reported to evolve into acute leukemia. We describe our experience with five cases, seen and managed by us over a 5-year period. All patients receiving supportive therapy died with one of them definitely known to transform to acute leukemia. The patient who survives till the time of writing received low dose continuous cytosine arabinoside infusion.
Opacification of both Cowper's glands and ducts is a rare finding in urethroqraphv.' Its demonstration almost always indicates an abnormality in the posterior urethra or posterior aspect of the bulbous urethra. Conversely, its visualisation may be a diagnostic pitfall, and may lead to misinterpretation. We present a case delineating both Cowper's glands and ducts, to illustrate its anatomy so as to help differentiate it from pathological conditions.
Traditional methods of treatment are extremely popular with Malaysians especially for psychiatric illnesses. Those who seek such treatment come from all cultures, social classes and different educational levels in this country. In one hospital as much as 49% of psychiatric patients had been to traditional healers . Some receive simultaneously traditional and modern modes of treatment. While many reports have been written on traditional healers such as the bomoh and spirit mediums, relatively less is written about Christian healers who practise exorcism. This paper describes two patients who had received psychiatric diagnoses of major illnesses, and who subsequently underwent Christian exorcism. The process of exorcism and the short-term and long-term outcome are reported.
The Cardiothoracic Department, General Hospital, Kuala Lumpur which was set up in April 1982, deals with a wide range of cardiac disease, general thoracic and also vascular cases. A total of 2,450 operations were performed from April 1982 to February 1987, and 79.3% of these were for cardiac cases (open and closed heart). This paper reports a review of the 1,110 consecutive open heart operations performed by the Department during the stated period.
One-hundred-and-thirty-one female stroke patients were identified in a retrospective analysis of female medical admissions to the Penang General Hospital during 1983. The hospital medical admission rate of women with stroke was significantly higher amongst the Chinese than the Malays [p < 0.001) or the Indians (p < 0.001). A higher proportion of Indians than Chinese or Malays presented within 24 hours of the onset of illness. The case fatality rate at discharge was 34% when patients taken home moribund were included as fatal cases. Such cases where patients were taken home at their own risk (AOR) were common among the Malays and the Chinese but did not occur amongst the Indians.
Study site: female medical wards, Penang General Hospital
The clinical course of 68 patients who had temporary transvenous pacing for complete heart block in acute myocardial infarction is reviewed. There were 59 male and 9 female patients, of which 32 were Indians, 20 were Malays and 16 Chinese. 48 patients had inferior infarct, 16 patients developed anterior infarct and 4 patients presented with combined anteriorinferior infarction. The overall mortality for complete heart block in this study is 44%. The mortality pattern is 25% for inferior infarct; 87% for anterior infarct and 100% for combined anterior and inferior infarct.
A patient with a cervical aortic arch associated with a coarctation of the aortic arch and a Tetralogy of Fallot presented to the General Hospital, Kuala Lumpur.
Temporary cardiac pacing is an established therapeutic modality in the treatment of heart block and bradyarrythmias due to various causes like drugs and metabolic causes and prior to permanent pacing. Temporary pacing using fluoroscopy is best but the image intensifier is not available to all medical units. The method of temporary pacing at the bedside is described in detail.
A survey of Kayans of Long A tip, Baram, Sarawak, was conducted in 1986 as part of the pre-requisite to the development of a primary health care system for the people of the Baram. A total of 178 Kayans of all ages were surveyed for decayed, missing and filled teeth. Of the aggregate 39.3% did not have any decayed teeth, 37.6% had no missing teeth and 93.8% had not had any fillings. Compared with their neighbouring Penans, the Kayans of Long A tip had a relatively better dental status.
Surgery for the persistent ductus arteriosus (PDA) is almost 50-years-old. It started with Robert Gross in 1938 who successfully ligated the PDA in a seven-year-old girl.! Incomplete obliteration, ligatures cutting through the ductus and recanalisation of the ductus remained troublesome possibilities with this method of dealing with the PDA. Dividing the ductus and suturing each divided end separately would eliminate these possibilities. Gross was quick to recognise this and advocated division in all cases to remove any doubt of incomplete obliteration. 2 Jones supported this concept but also stressed that division and suture of the PDA was not to be taken lightly for the fatal consequence that could arise from inexperience.f There were those who continued to have satisfactory results with ligation of the PDA and persisted with this method (Blalock." Clagett, Kirklin, Ellis and Coolev.' Panagopoulos, Tatooles, Aberdeen, Waterston and Bonham Carter"}, The debate continues between ligation on one hand, and division and suture on the other and it appears currently to favour the latter. This paper reviews our experience with surgery for the PDA over the past five years.
Acute dacroadenitis is a rare condition. This case illustrates the acute onset, typical pain and tenderness in the upper outer eye of an enlarged lacrimal gland with purulent discharge. Good response to antibiotics is usual.
A 50-year-old male had an acute jejunogastric intussusception complicating a Bilroth 11 gastrectomy done 20 years previously for peptic ulcer. Preoperatively, the diagnosis was suspected from the plain abdominal radiograph which was subsequently confirmed by barium meal. The patient had an uneventful recovery following resection of the intussuscepted segment and an end-to-end anastomosis. Although rare, the condition is serious and should be recognised promptly and treated surgically. The diagnosis should always be considered in a patient who has had a previous gastrojejunostomy presented with a sudden onset of epigastric pain, bloody vomitus and epigastric mass.
Adults who present with sleep walking as a primary complaint is unusual. Two such cases are presented and their association with night terrors and sleep talking discussed. Psychosocial stresses exacerbate sleep walking and acts of violence during the episode can be potentially lethal.
A case of fictitious illness in a young Malaysian Indian male is reported and its relation to the more usual presentation of factitious disorders is discussed. Pathogenesis of this condition and its management are also suggested. Factitious disorders present not uncommonly in this country and it is important for the general duty medical officer and primary care physician to be familiar with this condition.
Tuberculosis of the thyroid gland is a rare condition. A case of tuberculosis of the thyroid gland presenting as a solitary thyroid nodule is presented. Management is operative intervention and anti-tuberculous chemotherapy. The final diagnosis is made after histopathological confirmation of the typical appearances.