Coeliac plexus block has been described more than seventy years ago and is widely used for chronic pain management in upper visceral malignancies. The technique described here is a posterior approach using CT scan guidance with absolute ethyl alcohol. A case illustration of a patient with carcinoma of pancreas managed with coeliac plexus block for pain control is presented.
Summary: Home oxygen therapy programme is new in Malaysia. This programme enables children with respiratory insufficiency to be discharged home early.
Materials and Methods: Long term oxygen therapy was initiated using an oxygen concentrator in patients who i) remained hypoxic while breathing room air, ii) experienced desaturations of more than 20% during sleep as seen in patients with severe laryngomalacia and obstructive sleep apnoea syndrome and iii) had pulmonary hypertension with or without polycythemia. The median with first and third quartile values are presented for the quantitative variables.
Results: A total of 71 patients mainly children with bronchopulmonary dysplasia (BPD) (32) and bronchiolitis obliterans (12) were discharged home on this programme. The median age at which home oxygen was initiated in children with BPD was 5.0 (Q1:2 Q3:8) months. The median total duration of oxygen requirement for BPD was 8.0 (Q1:5, Q3:12) months. The median duration of home oxygen dependency was 3.5 (Q1:3, Q3:6) months. However children with bronchiolitis obliterans required longer duration of oxygen therapy compared to children with BPD i.e. median duration of 28 months (Q1:14.5 Q3:66). In other respiratory conditions the mean duration of supplemental oxygen varies some of which may be life long.
Conclusions: This paper has shown the importance of home oxygen program in children with respiratory disorders. It has significantly shortened hospital stay and thus saves hospital costs and prevents prolonged separation from the family.
A number of psychological approaches to alleviating psychotic symptoms have been reported in the literature. The latest technique among them is cognitive therapy (CT). This paper describes an open trial that makes use of cognitive psychotherapy to treat chronic drug resistant delusions (more than 2 years duration) in 20 patients with schizophrenia. The positive response of all patients with the absence of symptom replacement and maintenance of response at 3 months follow-up, seem to imply that this technique is useful and more effort needs to be invested into this new area of psychotherapy for psychosis. This paper also shows that those patients on risperidone maintenance respond better to CT than those on other neuroleptics.
Objectives: This was a cross sectional study conducted in the Paediatric Institute among infants and children with chronic respiratory symptoms with the following objectives: i) to determine the prevalence of gastro-oesophageal reflux in children with persistent respiratory symptoms, ii) to identify the clinical predictors of GOR (Gastro-oesophageal reflux) in children with persistent respiratory symptoms and iii) assess the validity of abdominal ultrasound, barium oesophagogram and chest radiograph in diagnosing GOR in these patients.
Materials and Methods: Forty-four patients were recruited over a period of six months. All the presenting symptoms were identified. The patients were subjected to chest radiograph, abdominal ultrasound, barium oesophagogram and 24-hour pH oesophageal monitoring.
The predictive validity of clinical symptoms, chest radiograph, abdominal ultrasound and barium oesophagogram were assessed. Twenty-four hours oesophageal pH was the gold standard to diagnose GOR.
Results: The mean age of patients was 9.1 months (1-58 months). Thirty-one patients (70.5%) were confirmed to have GOR by pH study. Respiratory symptoms alone were not useful to predict GOR. Cough had the highest sensitivity of 51.6%. stridor, wheeze and choking each had a specificity of 76%. Wheeze, vomiting, choking and stridor were identified to have high specificity (90-100%) in diagnosing GOR when any two symptoms were taken in combination.
Collapse/consolidation was the commonest radiological abnormality but had low sensitivity (35.5%) and specificity (53.8%). However hyperinflation on chest radiograph had a specificity of 92.3% with positive predictive value at 80% in diagnosing GOR. Barium oesophagogram has low sensitivity (37.9%) and moderate specificity (75%) in diagnosing GOR in children with respiratory symptoms.
Abdominal ultrasound was a valid mode of diagnosing GOR when there were three or more reflux episodes demonstrated during the screening period with a specificity of 90.9%. However the sensitivity was low ie 20-25%. The specificity increased to 90-100% when two positive tests were taken in combination (abdominal ultrasound and barium oesophagogram). However the sensitivity remained low (10-20%). Chest radiograph did not improve the predictive value when considered with the above tests. Combination of clinical symptoms were useful as clinical predictors of GOR. In the absence of a pH oesophageal monitoring, a combination of barium oesophagogram and ultrasound may be helpful in diagnosing GOR.
A total of 250 hepatitis B surface antigen positive sera were screened for antibody to hepatitis B surface antigen. It was found that seven (3%) sera showed concurrently circulating surface antigen and surface antibody to hepatitis B virus. The level of antibody to surface antigen was not affected by HBeAg and most of the cases were found in chronic hepatitis B carriers.
The identification of the Hepatitis C virus using molecular cloning techniques, besides making the term Non-A Non-B Hepatitis obsolete, enables the development of specific assays for the detection of antibodies in HCV-infected individuals, thus making it possible to obtain sero-epidemiological data of the disease. The carriage of Hepatitis C antibody varies worldwide. The disease is most prevalent in intravenous drug abusers or haemophiliacs. Parenteral transmission is the most important route of transmission. Sexual, intra-familial and perinatal transmissions are uncommon. About 40% could be community-acquired (sporadic). Diagnostic tests include enzyme-linked immunosorbant (ELISA) anti-HCV assay, recombinant immunoblot assay, HCV-RNA by polymerase chain reaction and HCV-Ag. More than 50% of acute cases becomes chronic and runs a benign and indolent course. About 20% progress to cirrhosis and some of these develop hepatocellular carcinoma. Several published trials have consistently shown that treatment with interferon in some patients is useful. There is however a relapse rate of 50%. Further trials with interferon and other anti-viral agents like ribavirin are awaited for more effective treatment.
We report a case of total occlusion of the left main coronary artery (LMCA) in a patient with chronic, stable angina. Total occlusion of the LMCA is rare and survival depends on the existence of collateral circulation. In LMCA disease, there is usually also disease in other parts of the coronary arterial tree.
A 43-year-old lady with long standing non-insulin dependent diabetes mellitus on glibenclamide presented with cholestatic liver disease. Initially she was thought to have developed primary biliary cirrhosis (PBC). When she made a spontaneous recovery following the withdrawal of glibenclamide, it became obvious that the patient had been suffering from drug-induced chronic cholestasis (DICC). The subtle differences between PBC and DICC are highlighted.
Vasomotor rhinitis is a common condition in Malaysia. Patients' dissatisfaction with medical treatment of this recurring condition leads them to seek other forms of traditional cures. This paper highlights the complications in such patients who seek traditional cures for their chronic condition.
The association of arsenical poisoning with the development of skin cancer is well-known. In Malaysia, arsenic has been shown to coexist with tin in tin-mining land. Our preliminary investigation has shown that the level of arsenic in well water from a tin-mining area is high. We report 3 patients with cutaneous lesions typical of chronic arsenical poisoning such as hyperpigmentation, keratoses and skin cancer. These patients have positive histories of previous domicility in tin-mining areas. We conclude that these patients developed chronic arsenical poisoning from drinking well water polluted with arsenic from the tin-mining soil.
Forty-eight patients treated surgically for chronic subdural hematoma in General Hospital Kuala Lumpur were studied retrospectively. The clinical presentations were insidious and nonspecific. A high clinical index of suspicion for this disease is required. Diagnosis is confirmed by CAT Scan of the brain with or without cerebralangiography. Treatment consists or burr-holes and drainage
A good overall assessment of the severity of illnesses of patients admitted to a general intensive care unit (ICU) is not without problems. The APACHE (acute physiology and chronic health evaluation) prognostic scoring system enables us to stratify acutely ill patients and compare efficiency of ICU therapy in different hospitals. This preliminary study carried out on 100 consecutive admissions to the ICU in University Hospital, Kuala Lumpur showed the spectrum of ICU admissions and the direct relationship between APACHE II score and mortality.
INTRODUCTION: Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM.
METHODOLOGY: A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension.
RESULTS: there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases.
DISCUSSION: the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.