This study examined out-patients' interpretation of prescription instructions at a community hospital. The results showed a wide range of misinterpretation with respect to drug name, dose schedule, and auxiliary labels. Age level, education and financial status emerged as the most significant variables associated with the patient's response. Therefore, both physicians and pharmacists may wish to review their traditional prescribing and dispensing procedures to help out-patients make better use of potent medication.
Continuous spinal anaesthesia using the incremental technique was used in nineteen high risk patients with multiple medical problems, seventeen of whom were elderly, for lower limb orthopaedic and pelvic surgery. An intrathecal catheter (18G/28G) was inserted under local anaesthesia via the lumbar interspinous space. Spinal anaesthesia was induced with small incremental doses of 0.5% bupivacaine hydrochloride through the intrathecal catheter to achieve the level of analgesia required for surgery. The duration of surgery ranged from 45 to 300 minutes (mean + S.D 100 + 37 min). The initial volume of 0.5% bupivacaine required for surgery ranged from 0.8 ml-2.0 ml (1.2 + 0.7 ml) and the total volume ranged from 0.9 ml to 3.1 ml (mean + S.D 1.4 + 0.7 ml). Haemodynamic stability was well maintained perioperatively. Only two patients required 6 mg of ephedrine and 1 mg of aramine respectively for a greater than 25% reduction in systolic blood pressure with induction of spinal anaesthesia. Intrathecal morphine 0.1-0.3 mg was administered to 15 patients at the end of surgery for postoperative pain relief with good effect. One patient developed late respiratory depression from an inadvertent overdose of intrathecal morphine. No neurological sequelae were noted and no patient developed a postdural puncture headache. The use of the microcatheter was discontinued in the U.S.A and Australia following four case reports of cauda equina syndrome with this technique. Current opinion, however, is that the reported cauda equina syndrome was due to the neurotoxic effects of lignocaine 5% that was used and not due to the microcatheter per se. Continuous spinal anaesthesia is now used widely in Europe when cardiovascular stability is desired in poor risk patients undergoing lower limb and lower abdominal surgery.
In the past year, stool specimens of 1,732 alien laborers were examined for intestinal parasites. There was no significant difference in the positive rate between males and females. All alien laborers were examined in 3 hospitals and the positive rates were 24.8% (191/769), 13.6% (109/804) and 12.6% (20/159). Broken down by nationality, the positive rates in laborers from Thailand, Indonesia, the Philippines and Malaysia were 23.9% (192/803), 20.3% (62/305), 12.1% (60/498) and 4.8% (6/126) respectively. Of all alien laborers, 17.2% (297/1,732) had single infections of parasites and 1.3% (23/1,732) had multiple infections. Opisthorchis viverrinii was the most prevalent parasite found in infected alien laborers. 91.5% of alien laborers were aged from 21 to 40-years-old and had positive rates of parasites reaching 91.0%. The time of arrival in Taiwan had an effect in all alien laborers examined for parasites. The positive rate in laborers arriving during April to June was 22.7% which was significantly higher than the 16.3% for laborers arriving in other months.
Malignant lymphoma of nasal septum is uncommon. It presents a problem in diagnosis to both otorhinolaryngologist and pathologist. This case report is about one such patient in whom the local disease has been controlled with the treatment of radiotherapy alone. However it is suggested that combined treatment of radiotherapy and cytotoxic therapy might improve the survival rate.
This retrospective study of radioactive needle implants at the Institute of Radiotherapy and Oncology, Kuala Lumpur Hospital serves as an audit of our practice as well as a demonstration of the usefulness of this technique of brachytherapy. A variety of tumour sites were implanted, of which over two-thirds involved the tongue and buccal mucosa. Although most of the implants were carried out with radical intent, one-tenth of these implants were performed for palliation. Radiotherapy techniques employed are described. The crude survival ranged from 1 month to 109 months while the disease free interval ranged from 0 months to 102 months.
Oxygen consumption values calculated by Fick's principle (cVO2) were compared to simultaneously obtained values measured by indirect calorimetry (mVO2) in two groups of patients; post-coronary artery bypass graft (post-CABG) and septic shock. In both groups of patients, oxygen consumption values derived using indirect calorimetry were higher than that from Fick's principle. Whilst the bias obtained between the two methods of measurement were of acceptable amount clinically, the limits of agreement were wide: -57 to 51 ml.min-1.m-2 in the post-CABG group and -101 to 67 ml.min-1.m-2 in the group of septic patients; indicating that significant differences exist between paired individual values such that cVO2 and mVO2 were not interchangeable in this study.
Appendicitis in pregnancy has a well documented high morbidity due to the difficulty in diagnosis. However, synchronous ectopic pregnancy and appendicitis is a rare event. This report describes the case of a 22-year-old lady of Bangladeshi origin who presented with both these conditions. The importance of prompt diagnosis and early surgical intervention, the inherent difficulties in diagnosis and the possible interrelated aetiological factors are discussed.
Extra pelvic endometriosis is rare and its presentation is varied. A case of pulmonary and umbilical endometriosis which presented as catamenial pneumothorax is presented. Due to poor response to medical treatment, a total abdominal hysterectomy and bilateral salpingo-oophorectomy was done to relieve the patient of her recurrent symptoms.
Endoscopic sinus surgery for frontal sinus mucocele is gaining popularity. A case study, and the CT scan of a large frontal mucocele with 1-year follow up is presented showing the lining of the sinus cavity well healed and the frontal sinus ostium as patent. Endoscopic sinus surgery, therefore, is a potentially useful method for treating large frontal mucoceles.
A retrospective six-month study of serum calcium and albumin in patients treated at the Kuala Lumpur Hospital was carried out. There were 19,291 subjects, of which the prevalences of hypocalcemia (corrected serum calcium of < or = 2.1 mmol/l) and hypercalcemia (corrected serum calcium of > 2.7 mmol/l) were 18.0% (3460 subjects) and 2.4% (468 subjects) respectively. Persistent hypocalcemia (a minimum of first two consecutive corrected serum calcium of < or = 2.1 mmol/l) was found in 408/19,291 subjects 2.1%). Serum calcium values of < 2.00 mmol/l were found in 98.5% of this group. Persistent hypercalcemia (a minimum of first two consecutive corrected serum calcium of > 2.7 mmol/l) was found in 108/19,291 subjects (0.5%) and 52/108 subjects (48.1%) had serum calcium values of > or = 3.0 mmol/l. 2902/3460 subjects (83.8%) and 313/468 subjects (66.9%) the hypocalcemia and hypercalcemia groups respectively failed to be retested (singletons). In the hypocalcemia group, 1115/2902 (38.4%) showed corrected serum calcium values of < 2.00 mmol/l), whilst 100/313 subjects (31.9%) of the hypercalcemia group had corrected serum calcium values of > or = 3.00 mmol/l. There were no significant differences between the mean corrected serum calcium between 3 age groups of the test population, namely in childhood ( < or = 65 years).
A patient who was troubled by the persistent passage of prostatic calculi following transurethral prostatectomy is reported. The pathogenesis of these calculi is postulated.
We examined human tissues infected by Burkholderia (Pseudomonas) pseudomallei which is endemic in Malaysia to study the types of inflammation invoked, and to look for histopathological clues to its diagnosis. The lesions which varied from acute to chronic granulomatous inflammation were not tissue-specific. In five autopsy cases, the inflammation was usually a focal or diffuse, acute necrotising inflammation with varying numbers of neutrophils, macrophages, lymphocytes and 'giant cells'. The 'giant cells' probably represent giant macrophages with phagocytosed leukocytes. There were numerous gram-negative, non-acid-fast, intra- and extracellular bacilli, occurring either singly or in chains. Intracellular bacteria within macrophages and 'giant cells' were so numerous as to resemble globi. This feature has not been previously reported and may be a useful diagnostic clue in melioidosis. In 14 surgical cases biopsies showed acute inflammatory lesions that appeared no different from acute inflammation due to other causes. In many biopsies, however, the inflammation was either an acute-on-chronic inflammation with a focal granulomatous component, or was purely granulomatous in character. Bacilli were difficult to demonstrate in surgical biopsies even with the gram strain.
An intensive health education programme geared towards increasing community's knowledge and inducing some changes in the attitude and behavioural factors towards the use of latrines.
A fractured tracheostomy tube is a rare complication; cases have been reported in the past, usually associated with prolonged usage in patients with chronic airway obstruction. We present here a fracture occurring in a new tube, and also describe a method for retrieving the tube from the tracheobronchial tree.
Household data from Malaysia are used to assess the roles of a number of mortality correlates in explaining the inverse relationship between the infant mortality rate (IMR) and socioeconomic development. Increases in mothers' education and improvements in water and sanitation are the most important household-level changes that accompany regional and temporal development and contribute to the inverse relationship between the IMR and development. One concomitant of development--reduced reduced breastfeeding--has kept the relationship from being even stronger. Continued prevalence of extended breastfeeding in the poorer states of Peninsular Malaysia and a narrowing of educational and sanitation differentials helped close the IMR gap between the richer and the poorer states.
The records of the Division of Stomatology, Institute for Medical Research, Kuala Lumpur, Malaysia, were reviewed for the incidence of odontogenic keratocysts of the orthokeratinised variety, during the 20-year-period, 1967 to 1986. Nine cases were found. The clinical, histological and radiological features of these cases are reported. Many features were similar to previous reports of this entity but a peak incidence in the second decade of life, an almost even distribution in the maxilla and mandible, and a distinct predilection for the Chinese were observed. It is suggested that these features may be peculiar to Malaysians.
The Koro syndrome, a 'special cultural psychiatric syndrome', is encountered in South China, Malaysia and Indonesia, especially among people of Chinese origin. There are only eight case reports of Koro from the Western hemisphere. We present a typical primary Koro patient from Israel. Jewish cultural mores are a contributory factor.
In this study whole blood cholinesterase activities were determined (tintometric method) of agricultural pesticide users exposed to organophosphorus compounds in Indonesia, Malaysia, Sri Lanka and Thailand. Analysis of the data demonstrated a universal relationship between cholinesterase levels and the time between the last exposure to organophosphorus compounds and the day of blood collection for cholinesterase determination. It is suggested that it takes approximately 5 days before whole blood cholinesterase levels revert to their normal values. No relationship between whole blood cholinesterase levels and the sex of pesticide users was demonstrated except in Sri Lanka where female sprayers had lower values. It is suggested that these lower values are associated with the anaemic status of female agricultural workers. No relationship between whole blood cholinesterase level and age was demonstrated. The measurement of pre-exposure cholinesterase values is essential for comparison of values after pesticide application.
A retrospective study of 37 intraocular foreign bodies treated over a five-year period is presented. Their aetiology, complications and visual results are discussed in the light of recent development in the management of serious ocular trauma.
Study site: Hospital Kuala Lumpur, Malaysia (UKM unit)