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.
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.
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.
A retrospective study of nine consecutive cases of triplet pregnancy delivered at the University Hospital showed an incidence of one in 6,349 deliveries. In seven cases the diagnosis was suspected, and confirmed either by radiography or ultrasonography. Pre-eclampsia and polyhydramnios were common ante-natal complications. The perinatal mortality rate was 74 per thousand. Overall, the first triplet had the best outcome in terms of Apgar scores. There were no perinatal deaths in those cases that were delivered by Caesarean section.
The case histories of two patients healed by animist treatment in the Iban tradition are reviewed by two psychiatrists. Both psychiatrists point to the difficulties in the evaluation of the background of the disease and of the mechanisms of its treatment by people not aware of the cultural and sociological aspects of eastern civilisation. The diagnostic classification of both patients by means of western medicine and the possible treatment of their disease are discussed. The failure of western medicine to understand the psychiatrical aspects of animist religions in the pathogenesis of diseases raises the question whether western medicine will be able to cope with the health problems of Iban (and other animists) sufficiently when their animist tradition will be replaced by western civilisation.
Acute nonspecific carditis with advanced heart block is rare. We observed nine cases with complete heart block and one with Mobitz type II block over an eight and a half year period. Temporary cardiac pacing was instituted in all while permanent pacing was required in six patients. No death was recorded.
Tuberous sclerosis is a disease with a well known association with renal masses, both cysts and angiomyolipomas. Reported here is a case of a 26 year old woman who had, in addition to angiomyolipomas of the kidneys, adenoma sebaceum, paraungual fibromas, shagreen patches and cerebral tubers.
Abnormal variants of plasma cholinesterase are a rarity in this region and to date there is only one reported case of suxamethonium sensitivity in a Malaysian population. We now report a case of a Malaysian Chinese patient who received suxamethonium, developed prolonged apnoea and on investigation found to be a homozygote for the silent gene. His family was screened for abnormal variants of plasma cholinesterase. The results are discussed.
The Singapore Cancer Registry started operations on January 1, 1968. It is a population-based registry that seeks to obtain basic epidemiological and clinical data on all cases of cancer diagnosed in Singapore. The results presented pertain only to Singapore citizens and permanent residents and cover the period from 1973 to 1977. Of special interest are the cancer patterns of the main ethnic groups in Singapore. Generally, the Chinese (76% of total population) have significantly higher risks for cancer; the most prevalent sites are the nasopharynx, esophagus, stomach, liver, and lung. Within the Chinese group are also dialect group differences. The Malays (15% of population) have the lowest rates for most sites, whereas among the Indians (7% of population), mouth cancer is an important site for both sexes. All these variations provide useful clues in the search for etiological factors.
The history of efforts to establish a cancer registry in Malaysia since 1961 is reviewed. In 1980, the staff of the Institute for Medical Research in Kuala Lumpur was authorized to develop an official registry that would combine the resources of the various university faculties, the hospitals, research institutes, and the Cancer Society. Special registries operate for oral precancerous conditions and for nasopharyngeal carcinoma (NPC). The topics of recent epidemiological studies include: a review of all cancers diagnosed at the University Hospital during 1972-74, the association of Epstein-Barr virus and NPC, social and environmental factors associated with NPC, oral cancers, and childhood cancers.
Between January 1974 and June 1980, 85 cases of cryptococcosis were diagnosed in the University Hospital, Kuala Lumpur, Malaysia. The diagnosis was based on positive culture of the organism in 81 cases; the remaining four were diagnosed on histopathological findings. Cerebral cryptococcosis was the most common presentation and Chinese are particularly susceptible (72% of cases). The incidence of the disease is shown to be far greater than previously suspected. Association with compromised host status is uncommon (14%). The local literature is briefly reviewed and the findings discussed.
The diagnosis and management of brain death is discussed in this paper. Criteria recommended by the Conference of Medical Royal Colleges and their Faculties in U.K. were used in the diagnosis of brain death. It is felt that brain death should be considered as death of the individual and a plea is made to draw up guidelines on management of patients with brain death.
A study of completed in-patient suicides at the University Hospital Kuala Lumpur (UHKL) and Hospital Bahagia Ulu Kinta (HBUK) between 1st January 1967 to 31st December 1987 were conducted. Records of completed in-patient suicides during the period were exhaustively studied. Only 18 cases were from UHKL and 23 cases were from HBUK. It was found that the suicide patients were mainly young Chinese males from the lower socio economic group. The main reasons for suicide were interpersonal conflicts and physical illness. Alcohol was not an important factor unlike patients in the West.. Suicidal intent was also important. Many of the suicides were committed during the early hours of the morning and they usually occurred at inaccessible places. The method was strongly influenced by availability. To the best knowledge of the author, this is the first study of in-patient suicides in Malaysia.