The interest in epidemic hysteria has been due to an increased prevalence of the phenomena in Malaysia in recent years. This paper describes the prevalence and characteristics of epidemic hysteria in Malaysia. An outbreak in a rural Malay lower secondary girls' school was described and the factors precipitating the outbreak were studied in detailed. The social interactions, native interpretation and psychodynamic constellations in the microcosm of tensions and interpersonal conflicts leading to the outbreak of hysteria were analysed and discussed. The paper also deals with the problem of social change within a closed-in rural community and how the various key personalities involved grappled with a problem thereby instituting social change.
Surveys in a number of European and American populations have found the frequency of occurrence of the heterozygotes for the gene for the dibucaine-resistant variant of cholinesterase (E.C.3.1.1.8) to be relatively constant. Similar surveys in Oriental population have shown low incidence of the same gene. This study done on the multi-racial population consisting of 3 major groups shows an absence of the gene for the dibucaine resistant variant of cholinesterase. This is supported by the clinical experience in the use of suxamethonium as a single dose in more than 25,000 individuals.
The incidence of congenital hypertrophic pyloric stenosis among 141,215 Chinese, Malay and Indian live births in Singapore from 1972 to 1974 was determined. The incidence per 100,000 live births among these ethnic groups are: Chinese 21.2, Malay 9.7 and Indian 35.0. Pyloric stenosis is not absent although rare in oriental babies.
The clinical features and pathology of 17 patients with gastrointestinal lymphoma are reviewed. The small intestine was the site most commonly involved. Emergency presentation was usual: 11 of the 17 patients presented as acute abdomen or gastrointestinal haemorrhage. The frequency of gastrointestinal lymphoma to carcinoma in the Chinese and Indians was comparable to that in the West but a higher frequency was found in the Malays and Orang
Asli.
Benign cystic teratoma of the ovary has a varied incidence, varying from 30 to 50 per cent of all benign ovarian tumours. This tumour tends to occur in the reproductive age group (20 to 40 years), and the majority of patients are married with children. About 40 per cent of patients are symptomless. Of those with symptoms, abdominal pain and mass are the commonest. Torsion is the most frequent complication encountered, and the presence of acute pain should make one suspect this complication. The tumour is bilateral in 10 to 20 per cent of patients. This high bilateral occurrence places a responsibility on the gynaecologist to inspect the opposite ovary in all cases of unilateral dermoid cyst of the ovary at the time of laparotomy. Germ·layer derivatives are predominantly ectodermal in origin, although both mesodermal and entodermal derivatives occur frequently.
Immunoglobulin G, A and M levels were determined in paired maternal and cord sera of premature, full term and postmature newborns of urban dwelling Chinese, Indian, Malay and full term newborn of the forest dwelling Orang Asli (Malaysian aborigines). The mean serum IgC level in the full term Orang Asli newborns (1254±441 mg per 100 mil is comparable to that of the Indians (1211±282 mg per 100 ml) and Malays (1169±286 mg per 100 ml) but these levels are higher than those of the Chinese
newborns (1092±270 mg per 100 ml). Statistical analysis indicates a significant dependence of cord serum IgG level on maternal serum IgG level in the . Chinese, Indians and Malays. In addition, in Indians the cord serum IgG was significantly dependent at 5% level on the gestation age. The fetomaternal serum IgG level ratios at term were equal to or just less than one. The cord serum IgM levels of the Chinese, Indian, Malay and Orang Asli newborns at term were 11.6.±. 6.5, 12.5.±. 7.3, 10.9.±. 5.8 and
16.7±6.9 mg per 100 ml respectively. Statistical analysis showed absence of correlation between cord serum IgM level and birthweight, gestation age or maternal serum IgM level in Chinese and Malays. In Indians the cord sera IgM level showed a dependence on the birthweight. Immunoglobulin A was present in 34.6%, 40.5%, 31.6% and 62.5% of full term Chinese, Indian, Malay and Orang Asli newborns respectively. These observations are discussed in relation to the immunoglobulin levels observed in populations residing in temperate and other tropical regions.
115 cases of enucleated eyes in the University Hospital, Kuala Lumpur, are reviewed. Trauma 36, Glaucoma 28, tumours and suspected tumours 24 and Infection 17 are the main causes. Trauma caused mainly by sticks, stones and sharp Instruments Is largely confined to the age group below 30. Primary narrow angle glaucoma accounts for 5 cases. The main types of secondary glaucomas are due to aphakia (12) and a hypermature lens (7) . Two thirds of the tumours are retinoblastomas and this Is the commonest cause of removal below the age of 5 years. There are 4 cases 01 malignant melanoma, all are Chinese. The average age Incidence Is 43 years, which appears to be a decade earlier than in the Caucasians. Preventive measures especially In regards to trauma and glaucoma are discussed.
A retrospective analysis of 102 cases of hydatidiform moles seen in the Maternity Hospital, Kuala Lumpur, Malaysia, is presented. The incidence was 1 : 669. The tumour was more common In the Malays and in the lower social class patients. No specific age group or parity group was exempted. Vaginal bleeding and amenorrhoea were prominent features. Hyperemesis and abdominal cramps occurred less commonly. The uterine size was larger than dates in 62.7% of patients. Pre-eclampsia complicated 23.5% of the moles and Its severity was inversely related to the uterine size. Spontaneous abortion occurred In 57.8% of patients at a mean gestational period of 19 weeks.
Study site: Maternity Hospital Kuala
Lumpur, Malaysia
This is an analysis of histologically proven neoplasms encountered in Sarawak in 1976 and 1977. There were 1447 benign and 1368 malignant tumours. The detailed breakdown of malignant neoplasms with their racial and sex distribution is reported, Lymph node involvement, with primary and metastatic lesions, constituted the largest single group with 22.3 per cent of all malignancies. The next in order of frequency was the Reproductive system with a marked preponderance of Cervical Carcinoma in females. The next in frequency were Skin cancers (8.85%) and Nasopharyngeal Carcinoma (8.4%). Primary liver cell cancer and Breast cancer constituted 5.85 per cent and 5.79 per cent respectively of all malignant tumours. The high prevalence of malignant neoplasms in Chinese is suggestive of racial predisposition.
Pregnancy was associated with cardiac disease in 0.94% of pregnancies. 0.66% with rheumatic lesions and 0.25'\'0 with congenital lesions. The Malays had a higher incidence than the Chinese and Indians. Most of the cardiac pregnancies were in patients between 20-30 years of age and gravida 1 to 4. Nevertheless. still about 30% of cardiac pregnancies were in patients 30 years and over in age and 20% in patient gravida 5 and above. Rheumatic lesions predominated. involving mainly the mitral valve. of which the major lesion was mitral stenosis. PDA. ASD and VSD were the major congenital lesions. Major antepartum matemal complications included arrhythmias. heart failure, anemia and pre-eclampsia. Of the arrhythmias. atrial fibrillation and sinus tachycardia occurred most commonly. A high incidence of prophylactic forceps and vacuum deliveries
was evident. There was one matemal death. The majority of infants were bom alive and well.
A system of tutorials preparing students for the Primary F.F.A.R.A.C.S. examination is described. It is suggested that this system would be suitable for teaching students in a peripheral training hospital.
This is a preliminary report of 46 sera tested for alpha-fetoprotein (AFP) by the Counter immuno-electrophoresis technique in which biopsies for histopathology were also submitted. In 42 cases the needle biopsy of the liver was available. The material was divided into two groups on the basis of AFP positive and AFP negative sera and their histological diagnosis. The overall positivity rate in proven Primary liver cell carcinoma was 64.2 per cent.
Two Malaysian Chinese male children are described with Wiskoll-Aldrich syndrome, which has rarely been reported in the East. Classical features were found, with bleeding and infections, low titres of isohaemagglutinins and IgM, but variable IgG and IgA. The immune response was broadly disturbed. Survival of one child was sufficiently long for a Iymphoreticular malignancy or appear.
This is an analysis of ovarian neoplasms encountered in Sarawak during the period January 1976-December 1977. There were 149 benign and 36 primary malignant tumours with an incidence of 44.3 per cent and 23.6 per cent respectively, in neoplasms 01 the Reproductive System. Amongst the benign ovarian tumours Dermoid Cyst
(Cystic Teratoma) was quite frequent (29.5 per cent). In malignant neoplasms Cystadenocarcinomas constituted 66.7 per cent of the total. A case each of Granulosa cell earcinoma, Adenoacanthoma and Endodermal sinus tumours, 4 of Dysgerminoma and 6 of metastatic ovarian tumours were also recorded.
7.8% (8/102) of paired sera sent for dengue investigation turned out to be positive for rubella Instead. Dual infection of dengue with rubella was observed in 3.8% (4/104) cases. The clinical features and the serious implications of misdiagnosis of rubella were discussed.
A review of all cases of nephroblastoma admitted to the University Hospital over a 10 year period reveals that its incidence relative to the other childhood tumours and epidemiological features are similar to other centres. The majority of patients presented with either stage III or IV disease. During the period 1968·1972 the number of defaulters was high and survival was poor. Following the introduction of treatment protocol, default rate has fallen and 5 of 7 patients have survived more than 2 years. Earlier referral and education of the parents should help improve the outcome for children with Wilms' tumour in Malaysia.
This is a report of 9 cases of Pilomatrixoma (Calcifying Epithelioma) recorded in 188 benign tumours of the skin and adnexa in Sarawak during 1976 and 1977, with an incidence of 4.7 per cent. Out of the seven Chinese patients four were females. One more female was a Kayan and the race of another female patient was not recorded. Except one, all were below the age of 20 years; the youngest being only 6 months old. In one lesion ossification was also detected.
A review of rhabdomyosarcoma in childhood reveals that the pattern and results of treatment have changed with the introduction of multimodal therapy. Outcome in our series have been poor due to advanced disease, poor compliance to follow up resulting from poor socio-economics and educational levels of our patients and their faith in traditional medicine. Improvement in the prognosis can only be anticipated with earlier diagnosis and reduction in defaulter rate.
Language studies were done on four multilingual dextral Chinese patients who developed dysphasia from various causes. The left hemisphere appeared to be dominant for all the languages in the four patients. All the languages and dialects were universally involved during the development of dysphasia. In one patient,
there was evidence of delayed restitution in the patient's mother tongue (Hokkien) comparing with Mandarin and English which were the languages used in the hospital and for reading.
An immunofluorescence test (IFT) using platelet suspensions was used to detect the presence of serum anti-platelet antibodies (APA) in the sera of Malaysian patients with idiopathic thrombocytopenic purpura. Of the 28 patients tested, 19 (or 68%) had detectable APA with percentage platelet fluorescence ranging from 34% - 80% (mean 51% +/- 10). Normal sera gave fluorescence values of 6 - 15% (mean 9% +/- 5). Sera from patients with SLE, thyrotoxicosis and dengue haemorrhagic fever gave mean values of 29%, 8% and 9% respectively. Additionally, no apparent correlation was observed between percentage platelet fluorescence and the severity of thrombocytopenia. The importance and significance of these findings are discussed.