One hundred and forty-five diabetic patients attending diabetic clinic over a four week period were fully examined in an adjacent eye clinic. The fundi were examined with a Halogen light direct ophthalmoscope and the Binocular Indirect Ophthalmoscope after mydriasis to assess the presence of retinopathy. 44.1 percent of patients examined had Opbthalmoscopicaliy detectable retinopathy while 11 percent were found to have 'serious diabetic eye disease'. The prevalence of diabetic retinopathy in Malaysia is comparable to those of Western countries and Japan.
Study site: Diabetic clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A recent anthropometric study of Sabah reported that 37.1 percent of children were nutritional dwarfs, 12.5 percent were acutely malnourished and 9.4 percent were stunted and wasted. It was also noted that Muruts were among the top five most malnourished ethnic groups in Sabah. The present study looks at the ecological basis of malnutrition among Muruts and concludes that a variety of interrelated factors, including the lack of education, climatic and soil conditions, poverty, food habits and taboos as well as diseases from poor sanitation and malaria contribute to the presence of malnutrition among rural Muruts. It is recommended that a multidisciplinary approach be taken to control and prevent malnutrition among the Muruts and that the single most important measure aside from malaria control is education of the people and the development of marketable skills.
Fifty-six living related renal transplants were performed between December 1975 and December 1980. All except eight of the recipients were male. The mean age was 29.5 years. Patient and graft survival were 86 percent and 73 percent at 1 year and 83 percent and 68 percent at 2 years respectively. Infection was the main cause of death and acute and chronic rejection were the main causes of graft failure. The donors were aged between 18 and 72 years old. There were 21 parent and 35 sibling donors. Donor nephrectomies were performed without mortality and our experience so far with the transplantation of kidneys from elderly donors has been encouraging.
Three consecutive cases of lacrimal gland carcinoma seen at the University Hospital during a twelve-year period are presented. One case was unusual, presenting at the age of sixteen years and developing metastases to the lungs. Adenoid cystic carcinoma is the commonest type of lacrimal malignancy and its clinico-pathological features and surgical management are discussed.
Forty patients with tubal ectopic pregnancies seen over an 18 month period are studied. Epidemiological parameters in the three major groups are compared. The diagnostic problems, signs and symptoms are discussed. Aetiological factors in this area are compared with changing trends in other centres. Pelvic inflammatory disease remains an important cause. The role of conservative approach in surgical treatment of ectopic pregnancy Z5 discussed. The crude incidence rate of ectopic pregnancy in Johore Baru Hospital between January 1978 and June 1979 is 1:358 deliveries.
Eighteen cases of anterior encephalocele treated at the University of Malaya Hospital between 1970 and 1980 are discussed, and the literature concerning this defect is reviewed. A detailed analysis of the microscopic abnormalities present in the surgical specimens is included, along with the relevant radiographic and demographic data. Anterior encephalocele is more common in Southeast Asia than elsewhere. The possible ethnographic and geographic implications are presented, as well as a discussion of the relevant embryology, in attempting to define possible etiologies for this malformation. The author's surgical approach to the repair of this defect and reasons for preferring a transcranial, intradural approach are described. Potential complications are enumerated.
A breeding colony utilizing a harem mating system was established to study the feasibility of breeding cynomoglus monkeys, Macaca fascicularis, in Malaysia. Two groups consisting of 10 females and one male each were evaluated over a 3 period. Forty births were recorded; one was stillborn, 11 died while nursing, and 28 were weaned. The average time to wean offspring was 230 days with an average weight at weaning of 0.858 kg. The average time for conception to take place after weaning was 50 days. Of the 20 breeder females, six produced three offspring each, nine produced two offspring each, four produced one offspring each and one remained barren throughout the project. Three different weaning systems were evaluated. The best method was caging the mother-infant pair within or adjacent to the breeding room followed by a two-part cage system which allowed the infant to continue nursing and also obtain solid food inaccessible to the mother.
Aneurysms of the sinus of Valsalva are uncommon disorders and are usually congenital in origin. When these aneurysms rupture into an intracardiac chamber, they may be silent initially but later give rise to progressive heart failure due to left or right shunting and aortic regurgitation. The mortality and morbidity in untreated cases is high. We report 13 patients with ruptured aneurysms of the sinus of Valsalva who underwent surgical repair. There were seven males and six females with a mean age of 24.5 years. Three patients were asymptomatic and five were in congestive cardiac failure. The majority of patients (61.5%) had insidious onset of symptoms, only 2 cases presenting acutely. The connection was between the right aortic sinus and the right ventricle in 11 cases and the non coronary sinus and the right ventricle in 2 cases. Associated cardiac anomalies included a ventricular septal defect (8 patients) and aortic regurgitation (6 patients). There was 1 post operative death and 1 patient required re-operation three months later for a recurrence of the fistula. All 6 patients with aortic regurgitation required aortic valve replacement. All patients remained well and asymptomatic during follow up ranging from 2 to 19 years.
A 61-year old lady presented clinically in unstable angina with ST-segment depression typical of myocardial ischemia. However, coronary arteries were completely normal at angiography. Exercise testing reproduced symptoms and ST-segment depression. A diagnosis of Syndrome X was made, an uncommon disorder of myocardial ischemia with normal coronary anatomy and excellent prognosis.
In Malaysia 1,307 randomly selected primary school children were screened to find out the prevalence of hearing loss and middle ear disorders. Seventy-six students (5.81%) failed the screening audiometric test. There were 95 students (7.26%) with middle ear disorders. History of ear discharge was absent in 24 out of 57 cases with CSOM (42.11%) (P less than 0.001). Forty-three out of 95 children having middle ear disorders passed the screening audiometric test (P less than 0.01 Fisher exact test). Screening audiometric test fails to detect about 46% of cases with middle ear disorders. Screening audiometric test and otological examination if conducted by the school health medical officers regularly will be able to detect almost all the cases with hearing loss and middle ear disorders.
A retrospective study was made to determine relative incidence of lymphoma subtypes in Malaysia. High grade non-Hodgkin's lymphoma was found to be common. Low grade non-Hodgkin's lymphoma and Hodgkin's disease were relatively rare in this Malaysian series. Non-Hodgkin's lymphoma of B-cell immunophenotype was four times as common as that of T-cell lineage. There was a high incidence of primary extranodal non-Hodgkin's lymphoma.
The aim of this study was to determine the frequency and specificity of HLA-A and B antibodies in multiparous mothers in the Malaysian population. 1,100 maternal serum samples obtained during normal childbirth were screened against a panel of 100 lymphocytes with known HLA antigen types for HLA antibodies by the complement dependent lymphocyte microcytotoxicity dye exclusion test. From the total number of 1,100 samples of maternal serum that were screened for HLA antibodies only 205 specimens (18.6%) tested positive for antibodies. The percentage of maternal sera which contained HLA-B specificities (10.6%) were significantly higher than those which contained HLA-A specificities (3.0%). Sixty maternal serum samples (5.5%) had high enough titres to be utilised as tissue typing reagents. Thirty nine maternal serum samples (3.5%) contained monospecific HLA antibodies. In this study the most common monospecific HLA antibodies characterised included the following specificities: A2, B5, B17 and B40. Malaysian multiparous mothers of gravida 3, 4 and 5 had a higher frequency for producing HLA-antibodies.
A retrospective review of patients with congenital dislocation of the hip (CDH) seen in the Institute of Orthopaedics, Kuala Lumpur General Hospital from 1975 to 1988 is presented. There was a female predominance of 17 to five. The average follow-up was 43 months and the average age at final assessment was 63 months. The results were assessed clinically and radiographically using Severin criteria. Eighty eight percent of the hips had excellent or good clinical results at final review compared with 40% of the hips which had excellent or good radiological grading (Severin I and II). Initial acetabular angle before treatment and types of treatment appeared to have a correlation with the final result. The incidence of avascular necrosis was 16%.
This case report highlights one of the common but usually unrecognised causes of sinus bradycardia in clinical practice. The reasons for misdiagnosis and/or delay in diagnosis of such a condition is also discussed.
Sixty eight consecutive cases of percutaneous renal surgery, percutaneous nephrolithotripsy (PCNL), were performed on 64 patients (male-41, female-23) at the Subang Jaya Medical Centre from April 1988 to July 1989. All the cases were done as a one stage procedure. Fifty eight stones were large renal or staghorn and ten were ureteric. Thirty cases (41%) were stone free after PCNL alone. Thirty eight cases had residual fragments needing extracorporeal shockwave lithotripsy (ESWL). Mean operating time was 109.6 +/- 36.0 minutes. Mean hospital stay was 4.5 +/- 1.8 days. At three months follow-up, 86% of the cases were stone free. The remaining had residual sand (less than 3mm). Minor complications occurred in six patients. None required major surgical intervention post PCNL.