226 peritoneal dialyses were performed on 100 patients. 28 patients presented with acute renal failure. Uraemia was the most frequent indication for dialysis. Peritonitis was an important complication and Acinetobacter species accounted for 51.5% of the positive cultures. Other complications included poor dialysate drainage and hypokalemia. Mortality was mainly due to causes unrelated to peritoneal dialysis.
PIP:
A total of 552 women in 1983 have undergone laparoscopic sterilization under local anesthesia with sedation in the family planning clinic at Maternity Hospital and the Specialist Center at Batu Complex. A review was made to evaluate the risks, benefits, and safety of outpatient surgery in view of the shortage of anesthetic personnel, operating theaters and costs to patients if general anesthesia were to be used instead. Anesthetic complications (0.9%) were found to be of a very minor nature, not requiring hospitalization. Surgical complication was higher at 3.8%. There was a high rate (21%) of difficulties encountered at operation, 15% for medical officers and trainees but only 6% for specialists. In summary, a very low complication rate was encountered with local anesthetics. The use of local anesthesia with sedation is advocated. This cuts down on costs, hospitalization and recovey time and overcomes the perennial problem of shortage of anesthetic staff and operating theaters. The rate of the surgical complications was related to the surgeon's experience.
Study site: family planning clinic at Maternity Hospital and the Specialist Center at Batu Comple
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).
A total of 23 patients with psychoses associated with thyrotoxicosis were admitted to the psychiatric unit of a University Hospital over a 13-year period, of which 20 patients were included in this retrospective study. It was found that a parallel relationship between thyrotoxicosis and psychosis appears to exist in six patients, while in the remaining 14 patients, the course of the two disease processes were largely independent of each other. Paranoid delusions and auditory hallucinations were the most prominent psychiatric symptoms. Depression was commonly seen even in patients who were not having an affective illness. In four patients, a mixed schizo-affective psychosis was seen, suggesting that the diagnostic distinction between the affective and schizophrenic reactions are often blurred in psychosis associated with thyrotoxicosis.
We report a retrospective study of all cases of toxic epidermal necrolysis admitted to the adult medical wards of the University Hospital in Kuala Lumpur over a 16 year period from 1967 to 1983. Over this period of time only 7 cases were encountered, suggesting the condition is rare in adults in our country. All the cases were females and the age ranged from 21 to 41 years. Four cases were due to drugs, 2 were idiopathic and one was attributed to Staphylococcal infection. One patient died. The other patients recovered completely with no sequelae.
Stevens-Johnson syndrome is relatively rare. The authors report a retrospective study of 34 patients seen at the University Hospital in Malaysia over 16 years and discuss the epidemiology, clinical features, complications, investigations, etiologic association, mortality, sequelae, course of the disease, and the use of steroid.
In this project, a retrospective study regarding the anaesthetic techniques, complications and the relevant monitoring aids needed during the procedure, is made from analysis of the 100 available anaesthetic records of cases done during the five years at the Urology Department, General Hospital, Kuala Lumpur. The total number of cases done during 1979-1984 was 112 but 12 anaesthetic record sheets were missing. The patients requiring renal transplant operation were representative of the end-stage chronic renal failure population of Malaysia with the usual high incidence of cardiovascular and biochemical abnormalities. Except for two cases of epidural anaesthesia, all the other patients received general anaesthesia. Induction was with intravenous barbiturate followed by muscle relaxant, neurolept or narcotic and halothane supplement for maintenance. There were no intraoperative or postoperative deaths due to anaesthetic complications. There were five cases of anaesthetic morbidity of which three cases had inadequate reversal of neuromuscular blocking agents and required postoperative ventilation and two cases had poor respiratory effort and required naloxone supplement. Less serious complications such as allergic manifestations were seen in three cases with use of the new muscle relaxant atracurium. The conclusion was that general anaesthesia using thiopentone for induction, pancuronium bromide for intubation and maintenance of muscle relaxation and neurolept fentanyl/droperidol and halothane supplement, all in doses tailored to the requirements ofa renal failure patient, is a suitable technique of anaesthesia for renal transplant operation. Atracurium, the new muscle relaxant, seems to be a favourable alternative to pancuronium bromide. However, as only five cases in our study received atracurium, further studies would have to be done to support it.
The role of breastfeeding in preventing malnutrition is considered in relation to the Bostock classification of early human development, its relevance to different forms of malnutrition and to general ecological considerations, including economics and the management and prevention of diarrhoea.
A retrospective study of 37 intraocular foreign bodies treated over a five-year period is presented. Their aetiology, complications and visual results are discussed in the light of recent development in the management of serious ocular trauma.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)
Skeletal radiographs of 122 patients treated by maintenance haemodialysis were reviewed retrospectively for bone disease. Significant radiological bone changes were very low at commencement of dialysis (2- 9%), as well as at six months of dialysis (6.1%). This figure rose to 19.7% when the total period of dialysis was considered. In the latter group, fractures occurred in seven patients (5.7%), erosions in 12 patients (9.8%), vascular calcification in 13 patients (10.7%) and osteosclerosis in eight patients (6.6%). Osteoporosis was noted to be very common (76.2%). Significant bone changes are hence rare in maintenance haemodialysis patients in Malaysia.
A retrospective study of 34 patients with supracondylar-condylar fractures of the femur admitted to the Alexandra Hospital, Singapore, from January 1979 to December 1983 was carried out. These fractures were surgically treated by AO principles and fixation, and the surgery performed mainly by the two authors. Using strict criteria adopted from Schatzker of Toronto, 1 it was found that 62% of patients had excellent/ good results. The importance of treating supracondylar-condylar fractures by AO principles and fixation is emphasised.
There is a high incidence of tetanus in the Malaysian state of Kelantan. Out of 162 reported cases of tetanus in Peninsular Malaysia during 1979 - 1984, 62 cases were from Kelantan, i.e. 38% of the total reported cases in Peninsular Malaysia. Thus a retrospective study was carried out to analyse the possible factors responsible for this high incidence. 62 cases of tetanus admitted to the General Hospital, Kota Bharu, over a period of 1979 - 1984 were studied.
Neonatal tetanus, though still existing, had been considerably reduced compared to the preceding five-year period (1975-1979). There was notable absence of cases in the two months to four-year age group, 24% of the cases occurred in the 10 - 20 years, and 29% in the age group 25 - 40 years. Since tetanus is a disease preventable by active immunization. l every effort must be taken to improve immunization coverage and increase the public awareness to prevent unnecessary loss of lives.
A retrospective study of the pathology seen in 1,000 consecutive appendicectomy specimens with a pre-operative diagnosis of acute appendicitis, was made in an attempt to find common factors which might throw light on the aetiology of the disease. Acute inflammation was seen in 775 cases. In 225 cases where no inflammation was seen, 168 appendices were associated with other pathology, i.e., lymphoid hyperplasia, fibrosis and tumour. In 57 cases the appendix was not inflamed. Acute inflammation was seen more in males and in patients aged below 30 years, while normal appendices were more commonly seen in females of reproductive age.
This paper describes the findings of a survey on perinatal cases in Kuala Lumpur. Information on the deceased infants and their deliveries were documented as well as selected social, demographic and anthropometric data on the mothers. This includes quality of the home environment in terms of presence of basic amenities. It was evident that the lower classes were better represented in the sample.
This paper also highlights a major problem in retrospective studies, that of successfully tracing eligible respondents. There were also cases of non-cooperation. Another problem which emerged, and one common to many developing countries, was the incompleteness of birth weight records.
Of the seventy cases of cerebral malaria seen at the Duchess of Kent Hospital, Sandakan between January 1984 and June 1986, 57 (81.4%) were due to plasmodia falciparum and 13 (18.6%) were due to mixed p. vivax--p. falciparum infections. Mixed infection cerebral malaria was associated with a more severe anaemia and may carry a poorer prognosis. Indigenous children under five years of age are particularly at risk of death from mixed infections.
One-hundred-and-thirty-one female stroke patients were identified in a retrospective analysis of female medical admissions to the Penang General Hospital during 1983. The hospital medical admission rate of women with stroke was significantly higher amongst the Chinese than the Malays [p < 0.001) or the Indians (p < 0.001). A higher proportion of Indians than Chinese or Malays presented within 24 hours of the onset of illness. The case fatality rate at discharge was 34% when patients taken home moribund were included as fatal cases. Such cases where patients were taken home at their own risk (AOR) were common among the Malays and the Chinese but did not occur amongst the Indians.
Study site: female medical wards, Penang General Hospital
Surgery for the persistent ductus arteriosus (PDA) is almost 50-years-old. It started with Robert Gross in 1938 who successfully ligated the PDA in a seven-year-old girl.! Incomplete obliteration, ligatures cutting through the ductus and recanalisation of the ductus remained troublesome possibilities with this method of dealing with the PDA. Dividing the ductus and suturing each divided end separately would eliminate these possibilities. Gross was quick to recognise this and advocated division in all cases to remove any doubt of incomplete obliteration. 2 Jones supported this concept but also stressed that division and suture of the PDA was not to be taken lightly for the fatal consequence that could arise from inexperience.f There were those who continued to have satisfactory results with ligation of the PDA and persisted with this method (Blalock." Clagett, Kirklin, Ellis and Coolev.' Panagopoulos, Tatooles, Aberdeen, Waterston and Bonham Carter"}, The debate continues between ligation on one hand, and division and suture on the other and it appears currently to favour the latter. This paper reviews our experience with surgery for the PDA over the past five years.
The effects of breast-feeding on infant health and mortality, particularly in the developing nations, are a matter of controversy and importance. The Malaysian Family Life Survey (MFLS) of over 1200 women has recently been the source of a great deal of valuable information on the influence of breast-feeding and interacting social variables on the incidence of infant mortality. Accuracy of reporting of breast-feeding duration is a key issue in the validity of studies of breast-feeding and infant mortality. This paper presents an illustrative analysis of the quality of breast-feeding data from the Malaysian Family Life Survey, using logit model schedules. Lesthaeghe and Page derived a logit model schedule of breast-feeding, summarizing empirical experience. This family of model breast-feeding duration curves is similar to the logit model life tables developed by Brass, and was intended for similar applications. To verify the MFLS retrospective breast-feeding reports, the observed median duration and variability were calculated for ethnic group/cohort subsets, and expected duration distribution curves were generated from the model using these observed parameter values. The expected curve generated from the model fit the observed curve of breast-feeding discontinuation extremely closely. Thus it is unlikely that any significant distortion of the pattern of discontinuation of breast-feeding occurred in data collection. Extensions of this method of data quality checking to other duration distributions are suggested.