Over a 17-year period, 15 patients with acute puerperal inversion of the uterus were managed at the University Hospital, Kuala Lumpur, an incidence of 1 in 4,836 deliveries. Injudicious traction on the umbilical cord before the uterus was well contracted, was probably the most important causative factor. Haemorrhage was more severe when removal of the placenta was done prior to correction of the inversion. Either the hydrostatic method or manual replacement were used but more often a combination of both techniques was found necessary. With careful management of the third stage of labour, this complication can be avoided.
1. 30 mg kg-1 chlorpromazine (CPZ) depleted more than half of the tissue histamine from lungs, stomach, ileum and skin of the normal guinea-pigs. However, the drug increased the tissue histamine content in scorbutic animals. 2. In contrast, reserpine depleted histamine from the four tested tissues in both normal and scorbutic animals, except those in the lungs of the control animals. 3. Ascorbic acid only depleted histamine from the stomach and ileum. 4. A 24 hr period was the time limit for CPZ to deplete the histamine in all the four tested tissues. 5. Histamine partially or completely recovered in the tissues after the next 24 hr.
Thirty-four patients with intracranial arteriovenous malformations seen in the University Hospital, Kuala Lumpur, over a is-year period were reviewed. A VM was found to be more common in young, male patients with preponderance Chinese origin. The advent of the Cl-scan has increased the detection of small A VMs and intracerebral haematomas proportionally. The majority of the lesions were situated in the posterior half of the brain unlike the distributions in patients in the West and in Singapore. On the other hand, most of the intracranial bleeding were subarachnoid haemorrhage; a presentation similar to the western community, but unlike that reported from Singapore. The treatment policy is not unlike the western community with good results in 82% of patients selected for surgery.
A case of actinomycosis occurring four years after the surgical removal of an impacted lower third molar is presented. The need for careful wound debridement and the use of antibiotics as a prophylactic measure is emphasized.
Malaya, an ancient crossroads of trade, was the recipient of Chinese and Ayurvedic humoral ideas and, later, those of medieval Islam. These ideas were readily accepted by Malays, since they are highly congruent with pre-existing notions among aboriginal peoples of Malaya involving a hot-cold opposition in the material and spiritual universe and its effects upon human health. Islamic Malays have adapted these aboriginal beliefs to correspond to the Greek-Arabic humoral model in matters concerning foods, diseases, and medicines. Although Malay theories of disease causation include such concepts as soul loss and spirit attack, along with 'naturalistic' ideas such as dietary imbalance and systemic reactions to foods, all of these theories can either be reinterpreted in humoral terms, or, at least, are congruent with the basic tenets of Islamic humoral pathology. Behaviors and beliefs regarding human reproduction, however, while essentially following a humoral pattern, diverge from Islamic, as well as traditional Chinese and Indian Ayurvedic, humoral theories. Unlike any other major humoral doctrine, Malay reproductive theory (like that of non-Islamic aboriginal peoples of Malaya) equates coldness with health and fertility and heat with disease and sterility. These ideas, in turn, are related to beliefs regarding the nature of the spirit world: the destructiveness of spiritual heat and the efficacy of cooling prayer.
An infant with bilateral congenital ring constrictions in the legs presenting with ischaemic gangrene of one leg is reported. The ischaemia was precipitated by greenstick fracture, the constriction ring producing a 'tourniquet effect' on the swollen tissues. Prophylactic release of deep annular constrictions is advised to prevent complications.
In this retrospective review of 16 children with vulvovaginitis due to Neisseria gonorrhoeae, the authors attempt to estimate the incidence of this infection and to ascertain the routes of transmission. From January 1977 to December 1982, 422 cases of gonococcal vulvovaginitis in women of all age groups were encountered at the University Hospital, Kuala Lumpur, Malaysia. Of these, 406 cases (96.2%) occurred in adults, and 16 cases (3.8%) occurred in children younger than 12 years of age. Penicillinase-producing N. gonorrhoeae (PPNG) strains were isolated from five (31%) of the 16 girls; all five cases were subsequently treated with cefuroxime and probenecid. The rest responded to intramuscular procaine penicillin. Although all patients appeared to be cured, only ten of 11 (two with PPNG) had test-of-cure cultures performed after treatment. Although interviewing the parents revealed no history of sexual contact in these children, nine of the girls were linked to culture-positive adult(s).
The problem of dental decay was studied in a sample of 495 Chinese preschool children in Petaling Jaya. The children; 253 males and 242 females ranged in age from 3-6 years. 18.6% of the children was observed to suffer from rampant caries. Only 18.8% were caries free. The dft values ranged from 2.9 +/- 3.12 at 3 years to 5.85 +/- 3.41 at 6 years. The overall mean dft for this group was 4.99 +/- 3.81. Dental treatment was very inadequate. The decayed filled tooth ratio was 6.5:1.
Nine adult tree shrews, Tupaia glis, recently imported from West Malaysia were visually examined for ectoparasites while under general anesthesia. Three shrews were infested by the sucking louse, Sathrax durus , and six shrews had louse ova belonging to this species; two shrews had neither lice nor ova. A total of 20 adult female, 10 adult male, and three third instar nymphal lice was collected. Lice were located on the head, flanks, and dorsal body of shrews while ova were recorded mainly from the anterior flanks but also from some adjacent host sites. The tree shrews appeared to tolerate the lice well although louse vector capacity was not assessed. The last date that lice were recorded from shrews was 22 days after colony set-up, and the last date on which seemingly viable ova were recorded was 64 days after set-up showing that the infestations were ultimately lost.
Obturator hernia is a rare clinical entity usually presenting with strangulation. Preoperative diagnosis is seldom made and this has contributed to a high. mortality. One should suspect a strangulated obturator hernia in an elderly thin female patient presenting with vague abdominal symptoms or intestinal obstruction associated with a positive Howship-Romberg sign. Urgent laparotomy is indicated to establish the diagnosis and for resection of bowel if indicated.
A prevalence study for intestinal parasites among 305 infants and young children was conducted at the Paediatric wards of the General Hospital Kuala Lum.pur, Malaysia. 40.8 percent of children were infected with at least one type of intestinal parasites: 39 percent were found to be infected with intestinal helminths and 4.26 percent with intestinal protozoa. Ascaris formed 17.38 percent of the infestation followed by Trichuris (14.75 percent) and hookworm (2.95 percent); 0.3 percent of the cases had Strongyloides stercoralis; 2.30 percent and 2.62 percent of the children had Entamoeba histolytica and Giardia lamblia respectively. Indian children were the predominant group found infected, followed by the Chinese and Ma lays. A significant drop in infestation rate of soil-transmitted helminths was detected among the Malays. The significance of the changing pattern in the epidemiology of soil-transmitted helminths is
discussed. A brief review of literature is also presented.
The case notes of twelve jaundiced patients, on whom percutaneous transhepatic cholangiography (PTC) were performed, are reviewed. PTC was carried out to differentiate the patients with intrahepatic cholestasis from those with extrahepatic biliary obstruction, and to identify the site and nature of the block. In eleven cases, the biliary trees were visualised, with the sites of obstruction in those present demonstrated and confirmed at subsequent laparotomies. There was no serious side effect from the procedure. PTC in our hands has proved an invaluable aid in the investigation of the icteric patients.
Incidence, aetiology, morphology, histology and symptoms of natal or neonatal teeth are presented. The commonly used terminology natal and neonatal teeth is adopted in this article. A case of an 8-week old girl with natal tooth and sublingual ulceration of the tip of the tongue is described.
Realising that family planning is not making a sufficient impact on the rural people as it is on the urban people, it was decided that it would be interesting to study the knowledge and attitude of a rural community towards family planning, The study sample consisted of 200 Malay married women - 100 acceptors and 100 non-acceptors from the Kuala Pilah District, The study commenced on 4 December 1978 and ended on 22 December 1978. A healthy climate of knowledge and attitude exists among rural Malay women. Only 2 percent nonacceptors had not heard of any method of family planning, and 99 percent acceptors, and 85 percent non-acceptors discussed family planning with their husbands. There was also enough evidence to show that birth rate does decrease as literacy rate increases. On the other hand, however, only 19 percent respondents approved of family planning practice before the first child. Also there is a dearth of information on family planning in the rural areas and not much was being done in utilising the two popular forms of mass-media - the radio and the television as a means of disseminating information on family planning. The study concludes with a recommendation that there is a need for sustained effort at improving knowledge and disseminating information, and nursing and nurturing the right attitudes towards family planning, It suggests that community leaders, women's clubs and private organisations be mobilised to participate more
fully in promoting family planning,