One hundred and seventy five patients treated for burns during 1983 and 1984 were reviewed. The majority of these patients were below eight years of age. These injuries were mainly sustained at home (83.4%) and were usually caused by hot liquids (41.7%). The infection rate was 57.1% and many developed septicaemia (21.7%). Mortality in patients sustaining burns involving greater than 30% of the body surface area was high at 52%.
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.
A review of our experience of 916 cases ofpartial bilateral vasectomy performed under local anaesthesia at the University Hospital, Kuala Lumpur during the
period between January 1971 and June 1980 is presented. Minor post-operative complications occurred in 5.8% of cases with a low post-operative infection rate of 1.2%. In 35% ofpatients, persistence of non-motile sperms in the semen were seen after at least ten ejaculations in each instance. In four of these cases non-motile sperms continued to persist into the sixth month of follow-up even after at least 50 ejaculations in each instance.
Disease patterns among outpatients seen at static and travelling dispensaries, as well as among hospital admissions and hospital deaths are compared between 1959 and 1974. While disease patterns of patients seen by travelling dispensaries show no change, patients seen by static dispensaries and hospital admissions in 1974 show a marked relative decline in infective and parasitic diseases and an increase in accidents, poisonings and violence. Causes of death in hospitals in 1974 were different, there being relative increases in diseases of early infancy, diseases of circulatory system, neoplasms, and accidents, poisonings, violence while infective and parasitic diseases, and diseases of the digestive system declined.
A review of malaria cases over a five year period from 1984-1988 at the University Hospital, Kuala Lumpur, Malaysia is presented. A total of 64 cases were recorded; 50% of which were due to Plasmodium falciparum, 40.6% were due to Plasmodium vivax, 6.2% due to Plasmodium malariae and 3.1% due to a mixed infection of Plasmodium falciparum and Plasmodium vivax. The breakdown of species type compared similarly with other studies conducted in the region. Of this total, sixteen cases were imported from Pakistan, India, Thailand, Indonesia, Sri Lanka, Vietnam, Madagascar and Mali. The presenting symptoms and the clinical findings were typical of a malaria infection. The main problem in the future will be the increase in imported cases of malaria.
The following factors influencing vocational success or failure were selected and studied for their predictive value in a Rehabilitation Centre, age, family background, educational level, work history and work level, motivation, mental ability and physical disability. Graded numerical scores from 1 to 3 were assigned to these factors according to Lane et al. A cut-off score was tested and found to distinguish the successful from the unsuccessful groups. The individual factors found to differ significantly in the two groups were work history and skill, motivation, and physical disability. Mental ability, however, could not be tested adequately.
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.
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.
More than half of 174 patients with end stage renal disease (ESRD) treated by the Department of Nephrology, General Hospital Kuala Lumpur in 1982 presented for the first time in uraemia, with no known renal disease in the past. Although about half of all patients seen in 1982 were treated by dialysis or transplantation, the great majority of the estimated number of patients developing ESRD in Malaysia in 1982 did not receive definitive treatment.
Ultrasound examinations were done to evaluate clinically palpable abdominal masses in 125 children. The examinations were normal in 21 patients. In 15 patients, the clinically palpable masses were actually anterior abdominal wall abscesses or hematomas. Final diagnosis was available in 87 of 89 patients with intraabdominal masses detected on ultrasound. The majority (71%) were retroperitoneal masses where two-thirds were of renal origin. Ultrasound diagnosis was correct in 68 patients (78%). All cases of hydronephrosis were correctly diagnosed based on characteristic ultrasound appearances. Correct diagnoses of all cases of adrenal hematoma, psoas abscess, liver hematoma, liver abscess and one case of liver metastases were achieved with correlation of relevant clinical information.
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%.
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.
This was a retrospective study of 177 patients above the age of 45 who were admitted to the Psychiatric Unit, University Hospital Petaling Jaya during the period October 1975 to October 1978. The available socio-demographic and clinical data from the case files were studied. The patients were divided into two groups - those with effective illnesses and those with non-affective illnesses. The differences in socio-demographic background and clinical symptomatology between the two groups and how the data compares with that in other studies was reported. The sick elderly person is an economic and psychological liagility to .his family and society. Absence of illness in the elderly not only fosters their continued independence but also improves the quality of their individual life. Though no definite correlations or conclusions could be arrived at, this study has sought to bring into awareness the necessity of delineating possible illness precipitating stress factors in the social and domestic environment of patients in later life.
Gastric cancer is an important cause of death among patients with malignancies in Malaysia. Survival of patients with gastric cancer is dependent on the stage at which diagnosis is made. We report our experience in dealing with gastric cancer in a major Ministry of Health Hospitals in Malaysia. A retrospective review of two hundred and fifty consecutive histologically proven gastric adenocarcinoma at Hospital Ipoh for the period January 1988 to 1998 was performed. The study confirms that gastric cancer is a disease of the elderly and has a male preponderance. It is also identifies the Chinese and Indians to be at increased risk of gastric cancer when compared to the Malays. The most striking finding in this study was the very late stage of disease at time of presentation. Eighty-two percent of the patients presented with stage IV disease and curative surgery was offered only to a 16% of them. In a substantial number of patients not even a palliative procedure was offered. Early detection is the key to improving survival in gastric cancer patients. There is an urgent need for clinicians to change their approach to the management of the disease. Patients with dyspeptic symptoms should be investigated early rather then wait for classical symptoms of gastric cancer.
The tumour marker CA19-9 is a sensitive marker for pancreatic, gastric and hepatobiliary malignancies. High CA 19-9 level indicates unresectable lesions and a poor prognosis. The objective of the study was to determine the significance and implications of elevated CA 19-9 levels in the serum. A one-year retrospective review of all patients who had CA19-9 measured in our Medical Centre was undertaken; 69 patients were found to have CA 19-9 level above the cut-off value (37 U/ml). Thirty-six patients had malignant and the remaining 33 had benign lesions. CA 19-9 was found to be elevated in malignancies of pancreas, colorectum, lung, liver and ovary. Benign conditions associated with elevation of CA 19-9 included disease of the hepatobiliary system, pneumonia, pleural effusion, renal failure and SLE. In two individuals, there was no obvious cause for the elevation of this marker. CA 19-9 levels were significantly lower in benign than in malignant conditions. In conclusion, elevated CA 19-9 may be found in patients with benign as well as malignant disease. Therefore, it is important (1) that elevated levels of CA 19-9 are interpreted in the light of the clinical presentation of the patient and (2) to be aware of the benign conditions that can be associated with increased levels of this marker. With these factors in mind, CA 19-9 can be used to assist in the diagnosis of pancreatic cancer and assessment of resection adequacy post-operatively.
A retrospective review of all bronchoscopy cases for investigation of lung cancer between January 1997 and December 1999 was done. The cases were included if endobronchial mass was visible (Group A) or when there was an abnormal mucosa and/or bronchial narrowing in the absence of a mass (Group B). All patients in Group A (n = 177) underwent endobronchial biopsy (EB) bronchial brushings (BB) and bronchial washings (BW). All cases in Group B underwent transbronchial biopsy (TBB), BB and BW. Only a small increase in the positive results for cancer was seen when cytology specimens (BB and BW) were added to EB (85.3% vs 88.1%, McNemar's P = 0.06) in Group A but there was a significant increase in Group B (37.3% vs 54.2%. McNemar's, P = 0.001). Therefore although cytology specimens did not significantly add to overall yield of positive results when endobronchial lesions were visible, when mass lesions were not visible, cytology specimens increased the yield by 16.9%.
Study site: Chest clinic, Hospital Sultanah Aminah (HSA), Johor Bahru, Johor, Malaysia
Medical audit is vital to ensure continuous quality assurance and quality improvements. We did a retrospective study to ascertain the adequacy of clinical documentation and the factors hindering early discharge after an acute stroke in a restructured hospital. The medical records of all patients with acute stroke who died or were discharged from a restructured hospital in Singapore in January and February 1999 were reviewed retrospectively. Demographic data and the presence or absence of clinical documentation were noted. Factors hindering the discharge of patients at Day 5, Day 10 of stroke and at final discharge were noted and classified into: stroke-related, complications of stroke, medical-related and social factors. There were 101 patients in the study cohort, 55 males (54.5%) and 46 females (45.5%). The mean age was 67.9 years (SD 12.3). Documentation in Barthel scores (0%), presence of depression (0%), mental scores (1.0%), visual problems (10.0%), bladder continence (39.6%), admission functional status (37.6%) and dysphagia (52.5%) were deficient. The mean length of stay (LOS) was 13.0 (SD 14.2) days. The main factor hindering discharge at Day 5 (90.4%), Day 10 (95.2%) and at final discharge (82.1%) was stroke-related problems. Poor function (60.3%) and dysphagia (15.8%) were the 2 most common stroke-related problems hindering final discharge. Complications of stroke, medical-related problems and social reasons hindered final discharge in 10.8%, 17.8% and 2.9% of patients respectively. This audit revealed inadequacy in clinical documentation in patients with acute stroke. The main hindrance to final discharge of patients was stroke-related problems. The 2 most important stroke-related problems were poor function and dysphagia.
Antrochoanal polyps are a rare clinical entity. In this review of patients treated between January 1996 and September 2002, there were 18 cases of antrochoanal polyps. The mean age of patients was 20 years. Nasal obstruction was the most common symptom (17 cases, 94%), followed by rhinorrhoea (44%), epistaxis (33%), postnasal drip (28%), and snoring (22%). Chronic sinus was the most common associated rhinological finding (50%). Various surgical approaches were used: endoscopic polypectomy and middle meatal antrostomy in seven patients (38.9%), endoscopic polypectomy and inferior meatal antrostomy in three patients (16.7%) and Caldwell-Luc surgery in one patient (5.6%). No complications were noted in patients treated with powered instrumentation, including the three patients in whom combined transcanine approaches were used. We concluded that powered endoscopic polypectomy was safe and effective. It allowed a more complete dissection and may diminish the chance of recurrence.