This paper discusses the spectrum of rheumatic diseases seen over a 24-month period from January 1986 to December 1987. Rheumatoid arthritis was the commonest rheumatic disorder seen, comprising of 47.1 % of all cases and ankylosing spondylitis was among the least frequent (0.9%). Most of the rheumatic diseases reported in the West are also seen in Malaysia. However, results of this study which is based on the hospital population may not be representative of the spectrum of rheumatic diseases in the our population.
Key words: Epidemiology, occurence, rheumatic diseases, Malaysia
Study site: Rheumatology clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
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)
The left atrial myxoma is important not only because of its relative frequency and diagnostic difficulty but because it can be successfully removed by surgery. However, if untreated, it invariably leads to death. We report three cases seen at the Cardiology Department, General Hospital, Kuala Lumpur in 1985.
Infantile or developmental coxa vara is a relatively infrequent localised dysplasia of unknown etiology which usually presents in the second or third year of life soon after the child begins walking. The clinical and radiological picture is usually characteristic especially when seen early. Early surgery leads to a satisfactory outcome. However, difficulty arises in diagnosis and treatment when patients present late, three cases diagnosed in adolescence at the University Hospital, Kuala Lumpur over the last 10 years are presented to increase awareness of this condition, which may be underdiagnosed, and the difficulties in diagnosis and treatment with late presentation are stressed.
The right heart pressures and saturations at different sites were measured in 87 normal individuals over a 16-year period during heart cardiac catheterisation. The right heart pressure measurements were comparable with normal values reported in Caucasian subjects. However, the total pulmonary vascular resistance and systemic vascular resistance were significantly different, though the pulmonary vascular resistance was comparable.
In this project, a retrospective study regarding the anaesthetic techniques, complications and the relevant monitoring aids needed during the procedure, is made from analysis of the 100 available anaesthetic records of cases done during the five years at the Urology Department, General Hospital, Kuala Lumpur. The total number of cases done during 1979-1984 was 112 but 12 anaesthetic record sheets were missing. The patients requiring renal transplant operation were representative of the end-stage chronic renal failure population of Malaysia with the usual high incidence of cardiovascular and biochemical abnormalities. Except for two cases of epidural anaesthesia, all the other patients received general anaesthesia. Induction was with intravenous barbiturate followed by muscle relaxant, neurolept or narcotic and halothane supplement for maintenance. There were no intraoperative or postoperative deaths due to anaesthetic complications. There were five cases of anaesthetic morbidity of which three cases had inadequate reversal of neuromuscular blocking agents and required postoperative ventilation and two cases had poor respiratory effort and required naloxone supplement. Less serious complications such as allergic manifestations were seen in three cases with use of the new muscle relaxant atracurium. The conclusion was that general anaesthesia using thiopentone for induction, pancuronium bromide for intubation and maintenance of muscle relaxation and neurolept fentanyl/droperidol and halothane supplement, all in doses tailored to the requirements ofa renal failure patient, is a suitable technique of anaesthesia for renal transplant operation. Atracurium, the new muscle relaxant, seems to be a favourable alternative to pancuronium bromide. However, as only five cases in our study received atracurium, further studies would have to be done to support it.
A food poisoning outbreak affected 114 female Malay students staying in a religious secondary school hostel in Klang. The students developed an illness mainly characterized by abdominal pain, nausea, vomiting and giddiness. The median incubation period in this outbreak was 2.5 hours. Laboratory examination of suspected food revealed 2.3 X10^6 Bacillus cereus organisms per gram of fried noodles. B. cereus was determined as the probable cause of this outbreak and the fried. noodles the most likely vehicle for the organism. An outbreak of B. cereus food poisoning is being reported in Malaysia for the first time.
Recent work with samples of black and white urban American women showed a clear behavioral sequence relating age at menarche to age at first intercourse to age at first birth. This paper shows that the linking of ages at menarche, intercourse, marriage, and first birth is a pattern which occurs in very diverse cultures. We present confirmatory data from the United States, Belgium, and Pakistan, and from Malay and Chinese women in Malaysia. We interpret our findings as indicating a biological process leading to (a) social interpretations of readiness for reproduction, and (b) persisting biological differences between early and late maturing women.
This paper reviews the pattern of glomeruler disease from 163 renal biopsies performed at the Institute of Urology and Nephrology. Nephrotic syndrome formed the largest group of patients. There is a high prevalence of SLE nephritis in our community. The histopathologic findings in our series were comparable to those from Western countries except for the lower incidence of membranous and membranoproliferative glomerulonephritis.
Spirometry was performed on 614 female subjects ranging in age from 13 to 69 years and comprising all the main races in Malaysia. They were divided into six age categories. Mean forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were 2.51 +/- 0.02 and 2.31 +/- 0.02l, respectively. Both FVC and FEV1 correlated negatively with age. Regression analysis revealed an age-related decline in FVC of 220 ml per decade of life. Multiple stepwise regression of the data for the prediction of an individual's FVC above the age of 20 years gave an equation: FVC(l) = 0.0312 (height)-0.022 (age)-1.64. Predicted FVC values derived from equations based on other populations were considerably higher than the observed mean in this study. Our study, therefore, reemphasizes the need to be cautious when applying formulae derived from one population to another. Grossly erroneous conclusions may be reached unless predicted equations for lung-function tests for a given population group are derived from studies based on the same population group.
We reviewed our data from 122 records of patients taking phenytoin for the treatment of various types of epilepsy and selected 15 (age range 10-43 years old) who were on phenytoin alone to calculate Michaelis-Menten pharmacokinetic parameters. The average Vm and Km for this age group was found to be 8.45 mg/kg/day and 6.72 mg/litre, respectively. Km was independent of age and weight. Vm correlated well with weight but there was no relationship with age.
An 18-year-old Malay lady was treated with high dose steroids for three and a half years for idiopathic thrombocytopaenic purpura. At 21 years, after a series of relapses, a splenectomy was carried out. In addition, two nodules at the hilum of the spleen were also removed. Histological examination of these nodules revealed features of Kaposi's sarcoma. Kaposi's sarcoma resulting from immunosuppression by corticosteroids is rare. Our patient is the first such case reported in Malaysia.
Obturator hernia is a rare clinical entity usually presenting with strangulation. Preoperative diagnosis is seldom made and this has contributed to a high. mortality. One should suspect a strangulated obturator hernia in an elderly thin female patient presenting with vague abdominal symptoms or intestinal obstruction associated with a positive Howship-Romberg sign. Urgent laparotomy is indicated to establish the diagnosis and for resection of bowel if indicated.
Eighty-eight (1.96%) out of 4,500 patients had teeth stained by tetracycline. The majority had yellowish-brown stains (59.1%), whilst 37.5% had greyish-brown and 3.4% had black stains. A large number of teeth (79.6%) were stained up to two-thirds of their crowns. The deciduous teeth, permanent incisors and first molars were most commonly affected (73.9%). Teeth are only stained by tetracycline if this drug is administered during their calcification periods. For aesthetic reason, the drug should not be prescribed from the fourth month of pregnancy till the seventh year of life. The social embarrasment due to such discolouration may be overcome by tooth bleaching and construction of tooth facings and crowns.
Realising that family planning is not making a sufficient impact on the rural people as it is on the urban people, it was decided that it would be interesting to study the knowledge and attitude of a rural community towards family planning, The study sample consisted of 200 Malay married women - 100 acceptors and 100 non-acceptors from the Kuala Pilah District, The study commenced on 4 December 1978 and ended on 22 December 1978. A healthy climate of knowledge and attitude exists among rural Malay women. Only 2 percent nonacceptors had not heard of any method of family planning, and 99 percent acceptors, and 85 percent non-acceptors discussed family planning with their husbands. There was also enough evidence to show that birth rate does decrease as literacy rate increases. On the other hand, however, only 19 percent respondents approved of family planning practice before the first child. Also there is a dearth of information on family planning in the rural areas and not much was being done in utilising the two popular forms of mass-media - the radio and the television as a means of disseminating information on family planning. The study concludes with a recommendation that there is a need for sustained effort at improving knowledge and disseminating information, and nursing and nurturing the right attitudes towards family planning, It suggests that community leaders, women's clubs and private organisations be mobilised to participate more
fully in promoting family planning,