Malignant melanoma is common among the whites of South Africa. In the black population, the tumor is much less frequent and occurs predominantly on the lower limb--particularly the sole of the foot. This study brings to light the anomalous situation that among the Eur-African-Malay population (those of mixed ancestry), malignant melanoma has probably the lowest incidence in the world.
We analysed clinical and histological diagnoses in patients admitted with liver-related illnesses in order to determine the spectrum ofliver disease in our community. In a total of 380 such patients, liver disease was sixfold more frequent in males than in females. Admissions for cirrhosis were more common amongst the Indian ethnic group. Indians constituted 39% of the admissions (expected 11. 7%), Chinese 37% (expected 51%) and Malays 21% (expected 36%) (~2 = 293, p = H 0.001). Liver histology from 179 of the patients was reviewed blind by one pathologist. Based on the histological findings, the pre-biopsy diagnosis was 'wrongin 75%of cases. The age standardized incidence rate of hepatocellular carcinoma was 22/100,000/year in males 225 and 5/100,000/year in females. However, the peak age of onset was in the seventh decade and the age specific incidence in males aged 60 years or older was 93/100,000/year. The ethnic group representation of patients with hepatocellular carcinoma did notshow a racial preponderance. This study highlights a public health problem related to acute viral hepatitis and alcohol abuse. It also confirms a high incidence of hepatocellular carcinoma
A review of the records at a teaching hospital in Kelantan revealed that 175 new cases of peptic ulcer disease were diagnosed endoscopically over a period of 5 years. The ratio of duodenal to gastric ulcers was 2:1. Male patients outnumbered females by 2.7:1. There was a disproportionately high number of Chinese patients. A striking observation was that an unusually large proportion (45%) of patients had presented with acute gastrointestinal bleeding. The implication is that peptic ulcer disease in this region may be underdetected; the diagnosis often coming to light only after a serious complication has supervened.
Cardiac complications comprise as much as 50% of perioperative vascular surgical morbidity and mortality. Using the Goldman multifactorial index for evaluating cardiac risk pre-operatively, 53 consecutive patients who underwent abdominal aortic aneurysm surgery were prospectively studied. Forty patients (75.5%) were also evaluated with echocardiography for assessment of left ventricular function. There were 14 (23.7%) peri-operative events, of which nine (17.0%) were acute myocardial infarctions--two of whom died (3.8%). The minor complications included three with hypovolaemic renal failure, and one each with acute respiratory failure and cerebrovascular accident. Patients with Goldman cardiac risk index (CRI) classes III and IV were associated with significantly higher risks of peri-operative complications (p less than 0.001), i.e. 77.8% and 66.7% respectively, compared with class II (22.7%) and class I (nil). Echocardiographic left ventricular shortening fraction (LVFS) of less than 28% helped identify high risk groups in all classes, although its positive predictive value was low (42.3%). Combining LVFS less than 28% with Goldman CRI categories II to IV improved the sensitivity to 91.7% and the positive predictive value to 61.1%. Careful pre-operative assessment using the simple Goldman index and echocardiography is helpful in identifying higher risk patients who would benefit from pre-operative stabilisation and more rigorous perioperative hemodynamic monitoring preferably including intensive care (ICU) management, so as to reduce cardiac complications.
Bladder stones in men are thought to be almost exclusively due to outflow obstruction. We studied the incidence of operations for urinary outflow obstruction and bladder stone to establish the relationship between these two conditions in Kelantan. In only 48 (31%) of 154 men undergoing removal of bladder stones was a procedure for outflow obstruction performed. Thus the remaining 69% had no clinical obstruction to account for their stones. Bladder stones were more common in prostatectomy patients than expected (42/193: 22%). We suggest that other causes may be important in the aetiology of bladder stones in Kelantan.
Although ageing is not yet a high priority issue for health planners, policy makers and clinicians in most developing countries, there will be a growing need in coming years to pay more attention to the important health issues associated with population ageing in the developing world. This paper reports some of the relevant findings of a cross-national study (sponsored by the World Health Organization) of the health and social aspects of ageing in four developing countries: Korea, the Philippines, Fiji and Malaysia. The key findings are compared and contrasted with those of a similar 11-country WHO study in Europe. In broad terms, the overall demographic, physical, mental health and social patterns and trends associated with ageing as demonstrated by age group and sex differences were consistent throughout the four countries studied. Comparisons with European findings in other similar studies underlined the fundamental universality of age-related changes in biophysical, behavioural and social characteristics. The importance of the family in developing countries was evident with about three-quarters of those aged 60 and over in the four countries living with children, often in extended family situations. Levels of adverse health-related behaviour and the prospect of changing patterns of morbidity with further increases in the total and proportional numbers of aged persons point to a need for emphasis on preventive health measures and programmes directed to the maintenance of the physical and mental health of the ageing population.
The effect of an antiprostaglandin, piroxicam, in preventing surgically induced miosis is studied. Patients undergoing extracapsular cataract surgery were randomly divided into the piroxicam and placebo groups. Intra-operative measurements of the pupillary diameters were performed. The stages of procedure at which they were measured were at the beginning of operation (Stage 1), after anterior capsulotomy (Stage 2), after lens nucleus delivery (Stage 3) and at the end of irrigation and aspiration (Stage 4). It is noted in this Study that the pupillary diameters were larger at stages 2,3 and 4 in the piroxicam group. The increase in the mean pupillary areas of the piroxicam group were statistically significant for Stages 3 and 4.
A prospective study was made of 40 consecutive patients who presented with peripheral arterial embolism to the Vascular Surgical Service in UKM. Atrial fibrillation was the most common source of the embolus. Twelve patients did not present until the affected limb(s) were in established gangrene. Thirty-two embolectomies were performed on 25 patients. Only 10 of these patients were discharged well with their limbs intact. Four patients required amputation because embolectomy did not restore viability of the limbs. Eleven patients died following embolectomy. The overall mortality for arterial embolism was 50%. Among the survival (n = 20), only 11 patients were discharged with their limbs intact. The cause of the poor result was related to the delay in definitive treatment and the poor general state of the patients. It was concluded that the prognosis for arterial embolism was very poor. This result needs to be improved and recommendations are made to achieve this.
Twenty-nine adult patients with culture-positive thoracic empyema were seen at the University Hospital Kuala Lumpur from 1984 to 1988. Cough, fever, chest pain, dyspnoea and weight loss were the common presenting symptoms. The empyema in 16 patients was associated with primary bronchopulmonary infections, nine occurred following thoracentesis of culture-sterile pleural effusions, two occurred as post-thoracic surgery complications, one following a subdiaphragmatic abscess and one as a result of a stab wound. The most common culture isolates were Streptococcus milleri, Pseudomonas aeruginosa and Klebsiella pneumoniae. Closed tube thoracostomy, the most common form of drainage procedure employed, was able to effect a cure or control of the empyema in 11 out of 19 patients in whom it was used.
The histological location of amyloid within various organs in 25 cases of systemic AA amyloidosis was studied with a view to determine whether different morphological patterns exist in this category of amyloidosis. Although morphological variations due to progressive severity of disease were observed, there were appreciable variations in the patterns of amyloid deposition in the kidney and spleen that could not be simply explained on those grounds. Eleven (61%) of 18 kidneys examined showed severe glomerular involvement with mild degrees of vascular deposition while the remaining seven showed predominantly vascular involvement. The glomerular pattern appeared to be more ominous, being significantly associated with severe proteinuria or chronic renal failure. In nine (69%) of 13 spleens examined, amyloid was confined to the walls of small and medium-sized arteries while in the remaining four, vascular involvement was less severe and amyloid was deposited mainly along the reticulin of the white pulp. Possible explanations for these different patterns included resorption and redistribution of amyloid within the body during the course of the disease, and variation in tissue deposition as a manifestation of polymorphism of amyloid proteins. The latter appeared more feasible in view of the recent demonstration of SAA polymorphism and AA heterogeneity in man.
The morphology, incidence and distribution of hyaline cells in ten cases each of pleomorphic adenoma, adenoid cystic carcinoma, adenocarcinoma and mucoepidermoid tumour were studied by conventional light microscopy. Results showed that the hyaline cells were identified in 60% of pleomorphic adenoma and in 20% of mucoepidermoid tumours, but were absent in adenoid cystic carcinoma and adenocarcinoma. Relative area estimation of hyaline cells in pleomorphic adenomas showed that this may range from 2.2% to 30.4% of the total tumour area. The usefulness of the hyaline cell as a diagnostic criteria in distinguishing between some of the salivary gland tumours was also discussed.
Radial tunnel syndrome refers to pain on the lateral aspect of the forearm as a result of compression of the posterior interosseous nerve within a tunnel with specific anatomical boundaries. Diagnosis of the condition is difficult because of its close association with lateral epicondylitis, which warrants different methods of treatment. Based on a cadaveric study, a new clinical test, the Rule-of-Nine test, is proposed to improve the diagnostic accuracy in radial tunnel syndrome. The test involves constructing 9 equal squares on the anterior aspect of the forearm and noting those squares where tenderness can be elicited.
The aim of this study was to assess the effects of treating lower urinary tract symptoms (LUTS) on the quality of sexual function in a one-year follow up. A total of 116 patients with LUTS received alpha-blocker treatment, 111 patients underwent transurethral resection of the prostate (TURP) and 70 patients with renal stones, with no or mild symptoms served as a control group. The patients were assessed at baseline, three months, six months and twelve months using the International Index of Erectile Function (IIEF-15). The surgical group exhibited some changes in the domain of IIEF-15. Patients in the medical group showed improvement in erectile function and intercourse satisfaction, while orgasmic, overall sexual satisfaction and sexual drive were relatively unchanged. In contrast, the surgical group suffered retrograde ejaculation and overall sexual dissatisfaction after undergoing TURP. TURP has been found to be associated with retrograde ejaculation intercourse and overall sexual dissatisfaction.
We studied the admission criteria and first 24-hour management of 62 asthmatic patients admitted from Accident and Emergency (A&E) department of a state hospital. Data was collected prospectively over a 6-month period from the doctors' medical records with reference to recommendations of the Malaysian Thoracic Society (MTS) on management of acute asthma. Peak Expiratory Flow Rate (PEFR) records were present in only 14.5% of the A&E notes and 54.8% of the ward notes. Most of these readings were below 75% of predicted normal values. Over half of the patients had records on ability to speak full sentences, and respiratory and pulse rates. Based on other records on criteria for life-threatening features (including arterial blood gases), 42% of patients studied had life threatening asthma exacerbations. Most received appropriate treatment as recommended by the MTS. We conclude that while most patients were admitted and treated appropriately, medical documentation regarding acute asthma assessment were inadequate in some.
Study site: Hospital Tuanku Jaafar, Seremban, Negeri Sembilan, Malaysia
Lymphomas, ranked twelve among all cancers world-wide in the 1990s, in which it is more prevalent in males compared to females. A previous study on lymphomas in East Malaysia for a period of 3 years from 1981-1983 showed that the pattern of lymphomas conformed to the general pattern observed in Asia. Current study reviews lymphoma cases from the Department of Pathology, Queen Elizabeth Hospital, Sabah between 1997 and 1999, with the aim of investigating if the spectrum and pattern in Sabah has since changed, a decade later. A total of 91 confirmed lymphoma cases were phenotyped with a panel of antibodies and classified using the new WHO proposed list of lymphoid neoplasms. The 1981-1983 series was reviewed and cases reclassified accordingly for comparison. There are 83 (91.2%) NHL and 8 (8.8%) HL cases in this series, a ratio of NHL to HL of 9:1. Of the 83 cases of NHL, 66 (79.5%) were confirmed B-cell type, 13 (15.7%) T-phenotype, 1(1.2%) null cell type and one case unclassified. Diffuse large B-cell lymphoma is the most prevalent, (65.1%), followed by Burkitt's lymphoma and follicular lymphoma, (10.6%) each. Lymphoma pattern concurs with the previous series from Sabah, with higher prevalence of diffuse large cell lymphoma and lower incidence of follicular lymphoma and HL, as seen elsewhere in Asia. There is an overall increase in the number of cases of NHL in the 1990s. However, the proportion of T-NHL is reduced when compared to the series in the 1980s.
The poor prognosis for patients with nasopharyngeal carcinoma is principally due to its advanced stage at the time of diagnosis. The symptoms and clinical findings at presentation of 56 patients with confirmed nasopharyngeal carcinoma is described and analysed. Recognising the common modes of presentation is essential to diagnose the disease at an early stage.
We retrospectively analyzed all patients presenting with upper gastrointestinal bleeding to Seremban Hospital over a one-year period. A quarter of the oesophagogastro-duodenoscopies (OGD) performed were performed as emergency for upper gastrointestinal tract bleeding. Gastric ulcers and duodenal ulcers were the two most common findings. Our results suggest that there is a male preponderance of 2:1, the Chinese were more likely to be affected and the elderly (> 60 years) were at highest risk.
This paper examines the surgical pathology associated with perioperative deaths in a country that is undergoing the transition from a developing to a developed nation status. The data from an ongoing nation-wide perioperative mortality study was prospectively collected for the period July 1996 to December 1997 and analyzed. The surgical pathology related to perioperative deaths in Malaysia is different from other developing and developed countries. While death from trauma and the late presentation of surgical conditions are similar to developing countries, infective gastrointestinal conditions were rarely encountered. Diseases associated with advanced age such as colorectal cancer, peptic ulcer, urological diseases and vascular conditions are beginning to emerge. As the country races towards a developed nation status, increasing life expectancy and changing life-styles are expected to influence the disease pattern. The planning of surgical facilities and manpower development must recognize the changes taking place.
A randomised single blinded clinical trial to compare the cost of cataract surgery between extracapsular cataract extraction (ECCE) and phacoemulsification (PEA) was conducted at Hospital Universiti Kebangsaan Malaysia (HUKM) between March and December 2000. A total of 60 patients were included in this study. The cost of a cataract surgery incurred by hospital, patients and households up to two months after discharge were included. The costs of training, loss of patients' income after discharge and intangible costs were excluded. Results showed that the average cost for one ECCE operation is RM1,664.46 (RM1,233.04-RM2,377.64) and for PEA is RM1,978.00 (RM1,557.87-RM3,334.50). During this short period of follow up, it can be concluded that ECCE is significantly cheaper than PEA by an average difference of RM 313.54 per patient (p < 0.001). Cost of equipment and low frequency of PEA technique done in HUKM were the two main reasons for the high unit cost of PEA as compared to ECCE.