We questioned 180 patients with end-stage renal disease on maintenance haemodialysis, chronic ambulatory peritoneal dialysis and those who had undergone renal transplantation at the Department of Nephrology, General Hospital, Kuala Lumpur. Twelve patients (6.7%) had consumed excessive quantities ofanalgesics prior to the institution of long-term dialysis or transplantation. Primary renal disease was considered to be analgesic nephropathy in seven patients (3.9%); in five patients (2.8%), analgesic abuse could have been a contributory factor to end-stage renal failure. Analgesic nephropathy is hence an uncommon cause of end-stage renal disease in Malaysia. However, it is important to be aware of the problem and to institute preventive measures as the cost of treatment for end-stage renal disease is prohibitive.
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 review of the home haemodialysis programme at the General Hospital, Kuala Lumpur between 1977 and 1984 revealed that out of 194 patients accepted into the programme, 187 completed home training and continued haemodialysis at home, seven died before having started on the training programme. The majority of patients required less than four months to be trained; 107 patients performed dialysis independently and 24 required assistance only for the insertion of needles. Patient survival was 93%, 80% and 69% at one, three and five years, respectively. Rehabilitation has been excellent and few social problems were encountered. Our experiences with home haemodialysis have shown that the majority of patients were able to assume responsibility for their own dialysis, and this has contributed to the good survival and excellent rehabilitation. Home haemodialysis was started in Boston in 1963, in Seattle and London in 1964 for the treatment of end stage renal disease (ESRD). It is now well-established as a therapy for patients with ESRD. Home haemodialysis has been practised in Malaysia since 1977. This report reviews the experiences of patients accepted for treatment between 1977 and 1984. All patients were treated by the Department of Nephrology, General Hospital, Kuala Lumpur, which supervises patients living all over the country.
In a prospective study performed on patients admitted to the medical and renal wards of General Hospital, Kuala Lumpur, over a period of 14 months from January 1982, we documented 12 new cases of analgesic nephropathy (AN). Since then up to July 1986, we have documented a further 16 cases of AN giving a total of 28 cases over a four-and-a-half-year period.
A prospective clinical study comparing 74 cases of rotavirus-associated diarrhoea and 100 cases of non-rotavirus-associated diarrhoea revealed a higher incidence of vomiting to be the only significant difference in the former. Bloody stools were seen in about 5-10%, fever in about two-thirds and respiratory symptoms in a quarter of cases regardless of aetiology. The overwhelming majority had mild dehydration of the isonatremic type. Hypokalemia was noted in a quarter of the cases in both groups.
Keywords: General Hospital Kuala Lumpur
Methicillin resistant Siaphylococcus aureus Is a common isolate from clinical specimens obtained from babies at the special care nursery of the Kuala Lumpur Maternity Hospital. Major Infections due to this organism were, however uncommon and the organism had in the majority of cases been present as a coloniser or as a cause of superficial infection. Netilmicin is a valuable antibiotic in the treatment of the severe 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
A six-month survey of 828 patients admitted to the Coronary Care Unit (CCU) of the General Hospital, Kuala Lumpur was carried out to ascertain whether the smoking habits of the patients predisposed them to definite coronary events and its immediate outcome i.e. early mortality (within seven days). The various ethnic groups were also screened to determine if they were at increased risk to coronary events in relation to other known risk factors. Three hundred and eleven patients - 239 males, and 72 females - had confirmed acute myocardial infarctions of whom 190 were smokers (172 males, and 18 females). Sixty-nine infarct patients died within the first seven days post-Ml: 35 were smokers (50.7%). Two-hundred and eighty other patients had non-infarct coronary events. Of these, 167 were smokers. In contrast, only 99 out of 237 patients admitted for non-coronary events, were smokers. It thus appeared that patients admitted to the CCU for suspected cardiac events had a greater incidence of confirmed acute myocardial infarction or acute coronary events if they were smokers (p < 0.001). Mortality from these coronary events was not seen to increase among smokers in this population sample. Women who smoked as a whole, were not found to be at increased risk to coronary events, but women smokers 60 years and older were shown to be at increased risk to developing confirmed coronary events (p < 0.01).
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
We present four cases of polymyalgia rheumatica who recently came under our care. The dramatic response of this disorder to low dose corticosteroids is well illustrated by our patients. The pertinent features of diagnostic value in this condition are highlighted.
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 prospective study of acute renal failure (ARF) over a three month period showed that 60 out of 22,033 inpatients developed AR"F (Serum creatinine exceeding 0.200 mmol/L). The ARF was oliguric in 22% and nonoliguric in 78%. Poor cardiac output or diminished intravascular volume, nephrotoxins and infections were the main aetiological factors associated with ARF in 85% of cases. Mean peak serum creatinine and blood urea values were higher in the oliguric than the non oliguric group. The oliguric group required dialysis more frequently (53.8% vs 4.3%) and had a higher mortality (53.8% vs 8.5%) than the non oliguric group. Nonoliguric ARF occurs more commonly and has a better prognosis than oliguric ARF. Acute renal failure is a serious condition with significant mortality and remains a frequent occurrence in the setting of large general hospitals. A Previous reports on acute renal failure in Kuala Lumpur comprised patients treated at the Department of Nephrology at the General Hospital Kuala Lumpur, but did not include patients with acute renal failure treated at other departments in the hospital. This report is based on a prospective study of acute renal failure occurring in the General Hospital Kuala Lumpur over a three-month period to evaluate the clinical spectrum of this disease, and its outcome.
Drug abuse is a major problem in Malaysia. Serious complications of intravenous drug addiction include septicaemia and infective endocarditis. We present nine cases of endocarditis occuring amongst drug abusers. The tricuspid valve was most frequently involved and the common aetiological organisms were S. aureus and Str. faecalis. There was a high mortality rate of 67% in our study, inspite of appropriate therapy. Early recognition of the disease and aggressive treatment is required to improve the associated mortality.
The Middlesex Hospital Questionnaire (MHQ) with its subscales on anxiety, phobia, somatic symptoms, depression and hysteria was devised by Crown and Crisp(1). it has been used to differentiate between neurotic and normal population. The MHQ has been translated into the Malay language and this paper shows the results of an attempt to validate this translated questionnaire in the Malaysian population. The translated questionnaire is found to have useful validity as a whole and also for subscales on anxiety, somatic symptoms and depression.
We report a patient with unusual manifestations of hyperthyroidism which initially suggested lymphoma. The pathophysiology of these features in thyrotoxicosis is discussed. The need to consider thyrotoxicosis in an otherwise unexplained case of lymphoid hyperplasia will be stressed.
Foreign bodies in the laryngotracheobronchial tree are not uncommon. Their clinical presentations, the radiological and endoscopic findings in sixteen cases that presented to the Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia were reviewed. The technique of removal is also discussed.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)
Between 1980-1986, 219 renal biopsies were performed on patients with lupus nephritis (LN) presenting at the General Hospital, Kuala Lumpur. There were 172 (78.5%) females and 47 (21.5%) males. The ethnic distribution of 48.4% Malays, 46.1% Chinese and 5.5% Indians reflected their proportional composition in the general population. Peak incidence (40.6%) of cases occurred in the third decade of life (20-29 group) followed by 26.5% and 20.1% in the second and fourth decades respectively. The median age was 24 for females and 27 for males. In both sexes, nephrotic syndrome was the commonest mode of presentation (62.2%) followed by proteinuria (20.5%). Acute oliguric renal failure occurred in 11 patients (5%) and 8 of these showed crescentic glomerulonephritis with more than 50% crescents. The commonest histological picture was diffuse proliferative LN (WHO Stage IV-44.7%) which included 70% (19/27) of those with crescentic disease. This was followed by membranous LN (28.8%) of which 6 (all males) had crescentic disease. 7 (12.3%) of our patients had crescentic nephritis with a female to male distribution of 14: 13, suggesting either more aggressive disease or delayed diagnosis in males.
Key words - Renal biopsies, lupus nephritis, nephrotic syndrome, proteinuria.
A total of 1,688 non-repeat upper gastrointestinal endoscopies performed over a 33-month period from April 1985 to December 1987 at a University Medical Unit in Kuala Lumpur was analysed for a profile of peptic ulcer disease amongst Malaysians. There was a total of 360 peptic ulcer patients with a gastric ulcer to duodenal ulcer ratio of 1:1. The male: female ratio was 2.8: 1 for duodenal ulcer and 1.8:1 for gastric ulcer, and 2.3:1 for peptic ulcer overall. In both sexes, gastric ulcers were seen at an older age group compared to duodenal ulcers.
Of the three main Malaysian ethnic groups of Malays, Chinese and Indians, Chinese of both sexes had the highest frequency of gastric ulcers. Chinese females had the highest frequency of duodenal ulcers.