A Brain laryngeal mask was assessed in fifty patients undergoing general anaesthesia who required controlled ventilation. The mask was inserted in all patients without any difficulty and the satisfactory seal obtained enabled ventilation in all patients in a wide range of positions. Airway obstruction occurred in seven patients secondary to downfolding of the epiglottis and this was rectified by reinsertion. The incidence of sore throat was 10%. The Brain laryngeal mask is a safe alternative to the tracheal tube for controlled ventilation during general anaesthesia.
Yaws is an infectious, non-venereal disease of the tropical countries, which is caused by Treponema pertenue. Gangosa and goundou were seen commonly in cases of yaws in Africa, particularly in the early part of this century. After successful WHO mass treatment campaigns, these conditions are rarely seen now. A case of yaws with gangosa, goundou, and a nasopharyngeal carcinoma is presented here for its rarity.
Circadian variations have been observed in the onset of acute coronary syndromes including acute myocardial infarction. We studied 422 acute myocardial infarction patients who presented to the coronary care unit of General Hospital Kuala Lumpur. Of the 318 (75.4%) patients whose data was complete, a circadian rhythm with bimodal peak was demonstrated. The second quarter of the day i.e. 6.00 a.m. to 12 noon was shown to have a significantly increased frequency of onset of acute myocardial infarction (p less than 0.05). Time delay in presenting to the hospital was also determined. This showed that 56.8% of acute myocardial infarction patients presented early, within four hours of the onset of symptoms. By six hours, more than 71% had sought hospital care. This early presentation to the hospital may offer a realistic opportunity for optimal thrombolytic therapy should this treatment modality be offered as routine to infarct patients.
Two hundred and five healthy Malaysian adults were scanned for the length of their kidneys and the cortical thickness by both the sector real time and linear array static B-scan diagnostic ultrasound. The length of the left kidney was found to measure 105 (98-111) mm for males, and 100 (94-106) mm for females on average from the sector scan and the static B-scan. The right renal length was 102 (96-119) mm for males, and 98 (92-103) mm for females on the average from readings of both scans. The left kidney is longer in length than the right kidney in males and females on both scans. The cortical thickness at the equator of the kidneys of males and females ranges from 12-14 mm. In both sexes, the lengths of the kidneys may be estimated by the distance between the first to the fourth lumbar transverse processes when there is no scoliosis.
A study was conducted to determine the prevalence of locomotor disability in a Malay Community in Tanjung Karang, Kuala Selangor in 1984. The causes of these disabilities, the mobility and occupational handicaps they caused and the types of treatment received were determined. Fifty percent of the households in this area were selected by stratified random sampling and all persons above seven years of age were included in the sample. The prevalence of locomotor disability was 3.9%. The prevalence among males was 5.2% and among females 2.6%. The prevalence increased with age, being as low as 0.6% in the 7-14 year age group and as high as 20.5% in the above 55 year age group. The disabilities resulted mainly from trauma (49%) and musculoskeletal and neurological problems (46.9%). Ninety percent (44 cases) had difficulty only in performance of daily activity and 20 cases (40.8%) had no mobility handicap whatsoever. Forty two (85.7%) of the 49 cases had received treatment.
Opacification of both Cowper's glands and ducts is a rare finding in urethroqraphv.' Its demonstration almost always indicates an abnormality in the posterior urethra or posterior aspect of the bulbous urethra. Conversely, its visualisation may be a diagnostic pitfall, and may lead to misinterpretation. We present a case delineating both Cowper's glands and ducts, to illustrate its anatomy so as to help differentiate it from pathological conditions.
Traditional methods of treatment are extremely popular with Malaysians especially for psychiatric illnesses. Those who seek such treatment come from all cultures, social classes and different educational levels in this country. In one hospital as much as 49% of psychiatric patients had been to traditional healers . Some receive simultaneously traditional and modern modes of treatment. While many reports have been written on traditional healers such as the bomoh and spirit mediums, relatively less is written about Christian healers who practise exorcism. This paper describes two patients who had received psychiatric diagnoses of major illnesses, and who subsequently underwent Christian exorcism. The process of exorcism and the short-term and long-term outcome are reported.
Surgery for the persistent ductus arteriosus (PDA) is almost 50-years-old. It started with Robert Gross in 1938 who successfully ligated the PDA in a seven-year-old girl.! Incomplete obliteration, ligatures cutting through the ductus and recanalisation of the ductus remained troublesome possibilities with this method of dealing with the PDA. Dividing the ductus and suturing each divided end separately would eliminate these possibilities. Gross was quick to recognise this and advocated division in all cases to remove any doubt of incomplete obliteration. 2 Jones supported this concept but also stressed that division and suture of the PDA was not to be taken lightly for the fatal consequence that could arise from inexperience.f There were those who continued to have satisfactory results with ligation of the PDA and persisted with this method (Blalock." Clagett, Kirklin, Ellis and Coolev.' Panagopoulos, Tatooles, Aberdeen, Waterston and Bonham Carter"}, The debate continues between ligation on one hand, and division and suture on the other and it appears currently to favour the latter. This paper reviews our experience with surgery for the PDA over the past five years.
A 50-year-old male had an acute jejunogastric intussusception complicating a Bilroth 11 gastrectomy done 20 years previously for peptic ulcer. Preoperatively, the diagnosis was suspected from the plain abdominal radiograph which was subsequently confirmed by barium meal. The patient had an uneventful recovery following resection of the intussuscepted segment and an end-to-end anastomosis. Although rare, the condition is serious and should be recognised promptly and treated surgically. The diagnosis should always be considered in a patient who has had a previous gastrojejunostomy presented with a sudden onset of epigastric pain, bloody vomitus and epigastric mass.
Three cases of pseudomembranous colitis seen over the past one year in the Medical Unit, University Hospital, Kuala Lumpur, are reported.
The historical background, spectrum of clinical presentation, diagnosis and treatment of the disease are discussed. Early and wider use of sigmoidoscopy in patients with predisposing factors to pseudomembranous colitis have resulted in increased diagnosis of the condition.
This is the first report in which a marine mollusc, Oliva vidua fulminans (olives), generally not known to be poisonous, was responsible for death in five children after consuming boiled olives with tamarind. The onset of symptoms was rapid 10 to 20 min after consumption of the olives. Signs and symptoms included nausea, vomiting, abdominal pain, tingling sensation around the lips, numbness around the mouth, drowsiness, lethargy and generalized weakness with paraesthesia in the limbs. The five deaths occurred within 3 to 4 hours after eating the poisoned olives and resulted from respiratory failure. Left-over olives from the affected household and freshly collected live olives had a toxicity of 14,200 mouse units (M.U.) and 15,000 M.U. per 100 g meat respectively. No other common chemical poison and organophosphorus insecticides were detected. The neurotoxic agent was acid and heat stable and was toxic at pH less than 4. Its action was similar to that of paralytic shellfish poisoning which was caused by toxins from certain dinoflagellates.
594 intravenous urograms done at the General Hospital, Ipoh, from January 1981 to March 1985 were reviewed for renal papillary necrosis (RPN). 11 cases (1.8%) of RPN were detected. Of these three were due to diabetes mellitus;eight were due to analgesic nephropathy. There was an equal incidence
in males and females, contrary to the experience in the West and Australia. RPN was observed mainly in the older age groups. Five of the 11 cases of RPN presented as renal colic.
More than half of 174 patients with end stage renal disease (ESRD) treated by the Department of Nephrology, General Hospital Kuala Lumpur in 1982 presented for the first time in uraemia, with no known renal disease in the past. Although about half of all patients seen in 1982 were treated by dialysis or transplantation, the great majority of the estimated number of patients developing ESRD in Malaysia in 1982 did not receive definitive treatment.
One hundred and forty-five diabetic patients attending diabetic clinic over a four week period were fully examined in an adjacent eye clinic. The fundi were examined with a Halogen light direct ophthalmoscope and the Binocular Indirect Ophthalmoscope after mydriasis to assess the presence of retinopathy. 44.1 percent of patients examined had Opbthalmoscopicaliy detectable retinopathy while 11 percent were found to have 'serious diabetic eye disease'. The prevalence of diabetic retinopathy in Malaysia is comparable to those of Western countries and Japan.
Study site: Diabetic clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
Fifty-six living related renal transplants were performed between December 1975 and December 1980. All except eight of the recipients were male. The mean age was 29.5 years. Patient and graft survival were 86 percent and 73 percent at 1 year and 83 percent and 68 percent at 2 years respectively. Infection was the main cause of death and acute and chronic rejection were the main causes of graft failure. The donors were aged between 18 and 72 years old. There were 21 parent and 35 sibling donors. Donor nephrectomies were performed without mortality and our experience so far with the transplantation of kidneys from elderly donors has been encouraging.
A pilot, field investigation of the prevalence and treatment of alcoholism in Southeast Asia (Singapore, Indonesia, Malaysia, Burma, and Thailand) and conducted. The methodology combined an informant study, interviewing leading alcohol and drug abuse authorities; utilising existing data; and clinical and naturalistic observation. The effects of modernisation, multiracial culture, and the unilateral focus on opiates are discussed; recommendations on treatment, education, and research are presented.
The role of fiberoptic bronchoscopy for rapid diagnosis of pulmonary tuberculosis was examined among 74 patients who were suspected of having the disease but had negative sputum smear for acid fast bacilli. Bronchial brushing and washing were routinely performed in all subjects and bronchial biopsy was performed on abnormal mucosa in 7 of them. The diagnosis of pulmonary tuberculosis was confirmed in 44.6% of the patients studied from smear examination, culture, histology or the combination of them. Rapid diagnosis was achieved in 54.5% of the confirmed cases from smear or histology within a few days of examination. Two of the cases had concomitant bronchogenic carcinoma. We conclude that the fiberoptic bronchoscopy is a useful investigation for this group of patients as confirmation of the diagnosis can be made fairly rapidly in a significant proportion of them, hence the treatment can be started confidently.