One hundred and eighty-three patients undergoing surgery were interviewed twenty-four hours following surgery to assess the quality of pain relief they received in the immediate postoperative period. Interviews were conducted using a standard questionnaire for all patients. They were asked to (1) rate the quality of pain relief they obtained on a Visual Pain Analogue Scale (VPAS-0 being no pain and 10 being the worst imaginable pain); (2) state whether they were happy and satisfied with the pain relief they received; (3) if dissatisfied, they were asked to give their reasons. 37.7% (69 patients) had moderate to severe pain--pain score greater than 6 on the VPAS. Most of these patients had undergone abdominal or major orthopaedic surgery. 32.7% (60 patients) were unhappy with their postoperative pain control. The main reasons for complaint from the patients were that analgesic injections were either not given promptly or were not given at all. The survey also highlighted the inadequate under-administration of narcotic injections in the postoperative period despite orders being written up. It showed there is an urgent need for setting up an Acute Pain Service for better postoperative pain control. An anaesthesiology based Acute Pain Service was started in October 1992.
A total of 1018 and 812 first degree relatives (FDR) of schizoprencies and controls respectively, were studied to find out the psychiatric morbidity in the families of paranoid and non-paranoid schizophrenia patients. The risk of schizophrenia and affective disorders was found to be independent of the probands subtype diagnosis. The risk for schizoid-schizotypal and paranoid personality disorders was found to be increased in the first degree relatives of paranoid schizophrenic, as compared to non-paranoid schizophrenic, thus suggesting that the psychopathology in the FDR may differ with the subtype diagnosis of the proband.
This retrospective study assessed the surgical outcomes of patients for whom the transobturator polypropylene mesh kit was used for the management of pelvic organ prolapse (Gynecare Prolift) in a tertiary urogynaecological centre in Singapore from January 1, 2006 to December 31, 2007.
Current diagnosis of melioidosis is based on bacterial culture and/or serology which is becoming increasingly useful. An IgM-ELISA using heat-killed whole cells of Pseudomonas pseudomallei was developed and compared with an indirect haemagglutination technique (IHAT) and an indirect immunofluorescent technique(IFAT). The IgM-ELISA using a P:N ratio of > or = 2 had a sensitivity of 91% and a specificity of 96%. All 3 assays were further used in a seroepidemiological survey amongst different groups of patients and healthy individuals. It was found that the IFAT performed better than the IHAT, detecting antibodies to P. pseudomallei in 6% of diabetics, 5% of pyrexics, 8% of pregnant women and 3% of farmers. For the same groups the IgM-ELISA detected antibodies in 1% of pyrexics, 8% of pregnant women and a further 14% of farmers. The IgM-ELISA was found to be sensitive and useful for the serological diagnosis of acute melioidosis.
The haemolysins produced by Aeromonas species were detected and compared by two assay methods--a modified blood agar plate assay and the rabbit erythrocyte haemolysin method. Both assays showed a high level of agreement (86%). The titres of the rabbit erythrocyte haemolysin assay correlated with the haemolytic zone diameter of the ox blood agar assay. In addition the agar haemolysin assay had simple media requirements, was easy to perform and results were well defined.
Dental employees in government institutions in a State in Peninsular Malaysia were screened for exposure to hepatitis B virus (HBV) in 1989. Almost all (96.8%) of the 217 employees responded. One quarter (24.8%) was positive for at least one serological markers to HBV; 2.4% had hepatitis B surface antigen (HBsAg) and 22.4% had anti-body to HBsAg (anti-HBs). The presence of HBsAg was unrelated to age, sex, ethnicity, geographical locality and occupations of the subjects. The prevalence of anti-HBs increased with age and was highest for ethnic Chinese (53.6%), followed by Indians (25%), compared to Malays (14.9%) (p less than 0.001) and were increased among dentists (53.1%) and assistant nurses (33.3%). The overall prevalence of HBsAg and anti-HBs were similar to the situation in the community. However, dentists and their chairside assistant nurses, with a higher proportion of Chinese, had higher anti-HBs prevalences compared with that of the general population.
The psychiatric morbidity following hysterectomy has received increasing attention. One of the sequelae of hysterectomy has been a brief, acute psychosis with excellent outcome, the etiology and pathomechanism of which is still unclear. Two Chinese patients born of Southeast Asian origin who manifested brief, acute psychosis following hysterectomy are presented. Therapy comprised drug treatment with low dose antipsychotics and benzodiazepines coupled with hypnosis and marital therapy to explore and treat the underlying pathology. Both psychotic states resolved. Follow-up at 12 months revealed stable mental condition in one subject; however, the second patient was lost to follow up. The impact of the womb's removal is explored in the context of the ethnicity of the patients and their sociocultural background.
Anomalous pancreatico-biliary junction (APBJ) is commonly associated with cystic dilatation of the bile ducts but recently, several cases without the cystic dilatation have been reported. We treated a young female patient with intractable back and epigastric pain of three months duration. The spine was normal on magnetic resonance imaging (MRI), but several lymph nodes were seen around the coeliac axis. An APBJ, a non-cystic biliary system, non-filling of the gallbladder and an irregular right margin of the bile duct were evident on endoscopic retrograde pancreatography (ERCP), which was highly suggestive of gallbladder (GB) malignancy. At surgery, the GB was hard with local infiltration of the bile duct. Numerous large para-aortic and supraduodenal lymph nodes were present and only a biopsy was possible. Details of the case are presented and the growing etiological importance of an APBJ, especially without cystic biliary dilatation in gallbladder carcinogenesis is discussed.
Twenty bilio-enteric anastomoses were performed or managed from May 1990 to December 1992. Recurrent pyogenic cholangitis (RPC) and pancreatic cancer were the commonest conditions which required drainage procedures. Roux-en-Y hepatico-jejunostomy (RHJ) was performed in 9 patients, 4 for RPC, one for pancreatic cancer, another for a cholangiocarcinoma, 2 following excision of choledochal cyst and one hepatico-jejunostomy was part of a Whipple reconstruction. Roux-en-Y side to side choledocho-jejunostomy (CDJ) was performed in one patient. Choledocho-duodenostomy (CDD) was performed in 6, 4 for obstructive jaundice due to choledocholithiasis, one for RPC and one in a choledochal cyst. One patient operated elsewhere presented with complications after a CDD. Palliative cholecysto-jejunostomy (CYJ) was carried out in 4 patients with pancreatic malignancy. All benign conditions were treated by hepatico-jejunostomy and choledocho-duodenostomy, while three patients with malignant conditions were treated by hepatico-jejunostomy. Permanent subcutaneous access loops were provided when recurrent problems were anticipated, 4 in RPC and one after subtotal resection of a cholangiocarcinoma. Based on this study, we found Roux-en-Y hepatico-jejunostomy a versatile drainage procedure, which was useful in both benign and malignant diseases.
A 24-year-old lady with recurrent upper abdominal pain, underwent surgery for cholelithiasis based on imaging diagnosis by ultrasound scanning. At laparotomy, the gall bladder could not be found either in its normal or ectopic locations. The diagnosis of agenesis of the gall bladder was confirmed by operative cholangiography. Duplication cysts of the hepatic flexure were discovered in the position normally occupied by the gall bladder. The stony hard faeces in the cysts were probably interpreted as gallstones on ultrasound. This rare condition is discussed and the importance of intraoperative cholangiography is stressed.
Two Malaysian Chinese male children are described with Wiskoll-Aldrich syndrome, which has rarely been reported in the East. Classical features were found, with bleeding and infections, low titres of isohaemagglutinins and IgM, but variable IgG and IgA. The immune response was broadly disturbed. Survival of one child was sufficiently long for a Iymphoreticular malignancy or appear.
The infectiousness with regard to HBV Infection of staff and patients in various units of the General Hospital, Kuala Lumpur
was assessed. It was found that all units, with the exception of the obstetric unit, were equally high risk areas. At least 50% of the patients in all these units had one or more of the markers. Among the medical staff, the anaesthetists had the highest
incidence of HBV markers (100%) while medical officers who had worked for three years or more were more likely to have to
have the HBV markers. The degree of infectiousness of the nurses In HDU and ICU/OT was found to be similar.
INTRODUCTION: In medical practice, some patients consult doctors for reassurance of normality, e.g. patients with throat discomfort. Therefore, medical graduates should be competent in diagnosing clinical normality. One way to assess clinical competence is by the objective structured clinical examination (OSCE).
METHODS: In 2002-2006, five batches of medical students who completed their otorhinolaryngology posting in Universiti Malaysia Sarawak were examined with the same OSCE question on clinically normal vocal cords. There were five subquestions concerning structures, clinical features, diagnosis and management. All students had prior slide show sessions regarding normal and abnormal laryngeal conditions.
RESULTS: The total number of students in 2002, 2003, 2004, 2005 and 2006 was 25, 41, 20, 30 and 16, respectively, and 100 percent responded. The average percentage of students with correct answers was 19.4, 2.4, 2.2, 21.2, and 2.4, in the subquestions 0.1 to 0.5, respectively, leaving the remaining relatively larger percentages with incorrect answers of various clinical abnormalities. A reason for these findings is examination fever by the students, who also assumed that all the stations had clinical abnormalities and required differentiating abnormalities from abnormalities, and not from normality. Without clinical normality OSCE questions, the assessment of the undergraduates' clinical competence in real life would seem incomplete.
CONCLUSION: This study showed that a significantly large percentage of students answered incorrectly in the clinical normality OSCE. This may mean that more clinical normality OSCE questions should be included in the undergraduate medical examination to help undergraduates practise the need to look for, and become competent in, clinical normality in real life.
INTRODUCTION: This retrospective review evaluates the prognostic indicators in the management of sudden sensorineural hearing loss (SSNHL) in otorhinolaryngology patients admitted to Brunei RIPAS Hospital.
METHODS: The review covered data collected from 1996 to 1998, and included patients who were treated with naftidrofuryl and dexamethasone. Their hearing improvement (more than 20 dB) in relation to pure tone audiogram patterns, hearing loss severity, vertigo, age of the patients and duration from symptom onset to time of treatment, were evaluated.
RESULTS: After exclusion of three patients with known causes of hearing loss, 50 patients with idiopathic SSNHL were reviewed. Six audiogram patterns were observed with good prognostic indicators in patterns 1 and 4, where respectively, 95 percent and 100 percent of the patients improved. The hearing improvement was noted in the majority of the patients with mild or moderate degree of hearing loss, especially noticeable in audiogram patterns 1 and 4. Initial vertigo gave poor prognosis in hearing (more than 33 percent patients with vertigo improved versus 88 percent patients without vertigo improved). Patients aged between 21 and 60 years appear to have better prognosis of hearing improvement compared to those who are outside of this age range. 92 percent patients whose treatment started within the first week of onset of hearing loss experienced hearing improvement compared to 84 percent patients whose treatment started in the second week after onset.
CONCLUSION: Fairly consistent with the previously-reported prognostic indicators are hearing loss severity, vertigo, age and duration of onset to treatment, though there was reasonably good prognosis when the patients were treated in the second week from hearing loss onset. Further findings of note were the six audiogram patterns and the good prognostic indicators in patterns 1 and 4.
Micropenis may be an important sign of underlying hypogonadism or pituitary hypofunction in the neonatal period. Penile lengths of normal newborns have been reported in many Western populations. However, the data may not be applicable in the Asian or the multiracial Malaysian population. Our study aimed to establish the normal penile length and testicular volume in term newborn infants in the major ethnic groups in Malaysia.
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.
A doctor's attire is important in making a positive first impression and enhancing the overall healthcare experience for patients. We conducted a study to examine the perceptions and preferences of patients and doctors regarding six types of dress codes used by doctors in different scenarios and locations. A total of 87 patients and 46 doctors participated in the study. Separate sets of questionnaires containing four demographic questions and 14 survey questions were distributed to the two groups. Most patients preferred doctors to dress formally in white coats regardless of the scenario or location, whereas the majority of doctors preferred formal attire without white coats. Both groups preferred operating theatre attire in the emergency department. Our findings confirmed that patients perceived doctors in white coats to be more trustworthy, responsible, authoritative, confident, knowledgeable and caring. There is a need to educate the public about the reasons for changes in doctors' traditional dress codes.
The clinical features and pathology of 17 patients with gastrointestinal lymphoma are reviewed. The small intestine was the site most commonly involved. Emergency presentation was usual: 11 of the 17 patients presented as acute abdomen or gastrointestinal haemorrhage. The frequency of gastrointestinal lymphoma to carcinoma in the Chinese and Indians was comparable to that in the West but a higher frequency was found in the Malays and Orang
Asli.
Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis.