Controversy surrounds the acceptance of hypertension as an independent risk factor for anaesthesia. In an attempt to identify variables that are associated with increased haemodynamic instability during surgery, the blood pressure profiles of 128 patients were analysed. The two variables that contributed most to the instability were pre-operative control of blood pressure and anaesthetic technique. To reduce the fluctuation in blood pressure, it is advisable for patients to be given a regional anaesthetic. Current therapy for hypertension appears to exaggerate the depressant effects of anaesthetic drugs. Care must be taken not only to prevent hypertensive episodes during surgery, but also hypotension.
Getting through major surgeries safely and timely with success and minimal complications is one of the great achievements of modern medicine. As the surgical techniques and the organs and systems involved become more varied, there are a number of important issues which determine the success of surgery. But one overriding theme is cardiovascular stability during and immediately after surgery.
To report a case of methylene blue related endophthalmitis. Observational case report. Review of clinical record, photographs. A 60 year old man developed endophthalmitis after methylene blue was accidentally used to stain the anterior capsule during phacoemulsification of cataract. His left visual acuity deteriorated from 6/12 to 6/36 two weeks after the operation. Despite intensive treatment with topical and intravitreal antibiotics, his condition deteriorated. A vitrectomy and silicone oil injection eventually managed to control the progression of the disease and salvage the eye. However the visual outcome remained poor due to corneal decompensation and retinal ischemia. Both vitreous tap and vitreous biopsy were negative for any organism. Methylene blue is extremely toxic to ocular structures and should not be used intraocularly.
We report a case of High grade Mucoepidermoid carcinoma of the middle ear. A 67 year old gentleman was referred to our centre for persistent otalgia associated with facial weakness for four months. Examination revealed a middle ear mass with House Brackmann Grade 3 Facial Palsy and ipsilateral lymhadenopathy. Biopsies suggested a squamous cell carcinoma of the middle ear, and he successfully underwent an Extended Temporal bone resection with External canal reconstruction and neck dissection. Postoperative Histopathology revealed that the tumour was in fact a High Grade Mucoepidermoid carcinoma. He received postoperative radiotherapy and is well one year post operatively.
Vomiting in pregnancy is a very common phenomenon, though not well understood. The extreme form, hyperemesis gravidarum can lead to severe complications. Articles published in the last decade in this field were searched and studied. Various aetiological factors were identified, the recent ones being the association of Helicobacter. pylori with hyperemesis, as well as the presence of cell free fetal DNA. The management of the condition involves symptomatic treatment along with antiemetic, pyridoxine and thiamine. Important role of alternative therapies like ginger and P6 acupoint stimulation in the treatment of hyperemesis has been identified.
A synthetic tracheostomy tube [non-metallic type] fracturing within three days of insertion is very rare but it could lead to serious complications such as acute asphyxia or sudden death. We report three such cases at our centre. Recommendations are made to closely observe patients on tracheostomy tube in the first seven days post-insertion of the tube.
The association of congenital hepatic fibrosis (CHF) with autosomal recessive polycystic kidney disease (ARPKD) is well known and occurs in approximately 50% of cases. However the association of CHF with autosomal dominant polycystic kidney disease (ADPKD) is less well known and less well documented. We report a child with neonatal onset of hypertension due to ADPKD who later develops portal hypertension due to CHF in childhood. A review of this rare association follows.
We report a newborn baby girl with acute dengue due to vertical transmission. A 31 year old factory worker of 38+ week gestation, gravida 5 para 3+1, developed acute dengue fever two days prior to delivery. She delivered a normal term baby girl by spontaneous vaginal delivery and recovered uneventfully without peripartum haemorrhage despite the presence of thrombocytopenia. The baby girl developed low grade fever on day four of post-natal life and except for the transient thrombocytopenia, also recovered uneventfully following three days of mild illness. The clinical diagnosis of acute dengue virus infection was confirmed by laboratory tests.
Premature Ovarian Failure (POF) is associated with subfertility. Despite efforts to induce ovulation, success rates are low. We report a case of POF spontaneously conceiving twins while on hormone replacement therapy.
A 12-year-old boy with moderate to severe bilateral mixed hearing loss was planned for hearing aid placement. During the process of making ear mould impression, the impression material accidentally entered the right middle ear. Removal of the ear mould impression was possible permeatally under general anaesthesia.
The purpose of this study was to study the determinants of self rated health in the low-risk pregnant women of Melaka Tengah in Malaysia. A total of 387 subjects were analysed. The role of mental health, psychosocial stressors, support from husband, coping skills, socio-economic status and pregnancy characteristics in determining self- rated health were studied. Health items were taken from the Duke Health Profile. Bad obstetric history, poor mental health, stress from the family were found to be significantly associated with poor self - rated health whereas good support from the husband was related to good self - rated health.
Cerebral Palsy (CP) describes a group of chronic conditions affecting body movement and muscle coordination caused by damage to one or more areas of the brain, occurring at any time during foetal development to infancy. This research was carried out to learn how parents of children with cerebral palsy (CP) had found and accessed services provided for them in Selangor and Kuala Lumpur. It was based in the Spastic Children's Association of Selangor and Federal Territory (SCAS&FT) among 96 of 201 parents of children who use the facilities and services provided by the SCAS&FT through questionnaires and face-to-face interviews. There was a satisfactory level of availability and accessibility of contacting and using the services provided by SCAS&FT in terms of respondent satisfaction. However, parents had varying levels of awareness of the different classes and activities carried out by the school. Efforts to improve knowledge regarding the services available for children with CP in the general population and among parents of these children should be promoted.
Records of 46 patients who were treated for primary hyperparathyroidism at King Khalid University Hospital, Riyadh Saudi Arabia from 1st July 2000 to 30th June 2006 were reviewed. Mean age at diagnosis was 44 years (range 13-70 years) and average duration of symptoms was 39 months (1 month to 11 years). There were 35 females and 11 males with a ratio of 3.2:1. Bone pains were the major symptoms at presentation in 45.7% followed by no symptom in 23.9%, renal stones in 15.2%, polyuria in 6.5%, while 4.3% each presented with depression, and constipation. Males had significantly more severe disease with higher serum calcium, higher urinary calcium excretion, and higher serum creatinine. Ninety six percent of patients had successful surgery and 4% (two patients) each had recurrence and hungry bone syndrome. It is concluded that PHPT in Saudi Arabia continues to be a symptomatic disorder with skeletal and renal manifestations occurring at a younger age and males having more severe disease. Further prospective studies are needed to verify our findings.
The elderly population in Malaysia is growing rapidly. Some of the most vulnerable are in residential care. Research is needed into the characteristics of this population to aid clinicians and policy makers in addressing the needs of this group. This observational, cross-sectional study aims to determine prevalence of undetected cognitive impairment and depression in elderly care home residents in Malaysia. One hundred and sixty-seven people over 60 years of age living in a state run residential home were interviewed. Validated assessment tools were used to measure dependency, cognitive impairment and depression. The prevalence of probable dementia is 36.5%, with increasing prevalence with age and level of dependence. Prevalence of depression is 67.0% (major depression 13.2%), with more depression in males and in the Indian population. None of the identified cases had been previously investigated or treated for dementia or depression.
Six hundred and fifty-five central venous catheters (CVC) in 496 patients in the intensive care unit of Hospital Sultanah Aminah were studied to determine the incidence and risk factors for central venous catheter-related blood stream infection (CR-BSI). CR-BSI was diagnosed in 38 catheters, giving an incidence of 9.43 CR-BSI per 1000 catheter days. The mean duration in situ was 8.4 +/- 4.9 days for infected CVCs and 6.0 +/- 3.8 days for non infected CVCs (p = 0.001). CVCs inserted in ICU had the highest infection rate (9.4%) compared to those inserted in the operating theatre (1.4%) and ward (2.8%) (p = 0.001). The highest rate of CR-BSI occurred with 4-lumen catheters (usually inserted when patients needed total parenteral nutrition) with a percentage of 15.8%. The majority of the CVCs (97.9%) were inserted via the subclavian or the internal jugular routes and there was no statistical difference in CR-BSI between them (p = 0.83). Number of attempts more than one had a higher rate of CR-BSI compared to single attempt with percentage of 7.0% vs 4.8% (p = 0.22). The top two organisms were Klebseilla pneumoniae and Pseudomonas aeruginosa. In conclusion, the incidence of CR-BSI in our ICU was 9.43 CR-BSI per 1000 catheter days. The risk factors were duration of CVC in situ, venue of insertion and use of 4 lumen catheter for total parenteral nutrition. The site of insertion, number of lumen up to 3 lumens and the number of attempts were not risk factors.
The purpose of this retrospective study is to determine whether there is a correlation among overweight, gender and the risk of development of spontaneous cerebrospinal fluid (CSF) rhinorrhoea. The clinical data of eight patients diagnosed with spontaneous cerebrospinal fluid rhinorrhoea who had been treated at our tertiary referral centre between 1998 and 2007 were assessed. Demographically, seven patients were female and one male with ages ranging from 14 to 53 years with a mean age of 43.6 years. This observation revealed that all patients were overweight with a mean body mass index (BMI) of 32.5 kg/m2. This study suggests that there is a trend of increasing BMI to the risk of developing a spontaneous CSF rhinorrhoea.
This study was conducted to asses the future physicians' habits, knowledge and attitude towards smoking. These factors influence the credibility of future Malaysian physicians as advocators and treatment providers. A cross sectional study was carried out among medical students at the Medical Faculty, University Malaya. Knowledge on smoking was evaluated on the total scores for knowledge questions, with one point and zero for each correct and incorrect answer respectively, to a maximum of six potential points. Attitude towards smoking was measured by summation of scores on attitude items; each item was scored from five points for "against smoking" and one point for "favourable to smoking". The possible score ranged from 10 to 50. The response rate was 79.4%. Prevalence of overall smokers was 4.4%. The mean knowledge score among smokers (4.30 +/- 2.17) was significantly lower than nonsmokers (5.19 +/- 1.28). The mean attitude score was higher among non-smokers (44.30 +/- 6.54) than smokers (39.86 +/- 10.93). The result from this study showed that smoking prevalence was lower compared to previous studies done in Malaysia.
This study was conducted to determine a safe vertical musculo-fascial plication distance in abdominoplasty operation in order to avoid the risk of developing respiratory distress during the post operative period. Abdominoplasty is a surgical procedure that removes excess abdominal skin and fat (panneculectomy), and tightens lax anterior abdominal wall muscle; in which musculo-fascial plication is a major component of abdominoplasty in patient with significant divaricating of the recti muscles. Respiratory decompensation may occur as a result of undue plication which reduces the intra abdominal volume with diaphragmatic excursion leading to abdominal compartmental syndrome. Fifty six patients for abdominoplasty were selected prospectively, during the period from June 1998 to February 2004, male to female ratio 1:13, mean age 39.5, mean weight 95.2 kilogram. To determine a safe plication distance (PD). The difference between two pre-operative measurements of the abdominal circumference was measured, before (BB) and after (AB) application of abdominal binder. The safe plication distance (PD) in centimeters = (BB) - (AB). The mean plication distance is 13.5cm. The changes in the pulmonary functions test before and after surgery were clinically insignificant. Pre-operative determination of safe plication distance is simple and convenient method which reduces the risk of developing respiratory distress in patients undergoing abdominoplasty in the post-operative period.
Peripheral arterial disease (PAD) is stenosis or occlusion of peripheral arterial vessels by atherosclerotic plaque. It may present as intermittent claudication, rest pain and impotence. PAD of the lower limbs is the third most important site of atherosclerotic disease after coronary heart disease and cerebrovascular disease. Increasing age, family history, smoking, hypertension, dyslipidemia and more decisively diabetes are significant risk factors. PAD is a clinical condition that has often been neglected, underdiagnosed, undertreated and has a serious outcome. It may lead to nonhealing wounds, gangrene and amputation of the lower limbs. Hence, early identification of patients at risk of PAD and timely referral to the vascular surgeon in severe cases is crucial.