Brain laryngeal mask (BLM) was used to assess its suitability in 50 spontaneously breathing patients by one lecturer and 4 Medical Officers. Insertion of the laryngeal mask was successful at the first attempt in 42 patients, second attempt in 7 and third attempt in one. The incidence of airway obstruction secondary to downfolding of the epiglottis, which was corrected by reinsertion, was 16%. Post-operative complications included clenching of teeth in 5 patients, vomiting in 2 and excessive salivation in 3. The incidence of sore throat was 10%.
Seventeen patients with small cell lung cancer (SCLC) were treated with cyclophosphamide, adriamycin and vincristine (CAV) combination chemotherapy. The overall response rate was 76.5% with 47% achieving complete response and 29.5% partial response. In limited and extensive stage disease, complete response was achieved in 67% and 36.5% respectively. Chinese were the predominant ethnic group affected (82%). Six patients presenting with superior vena cava obstruction responded significantly to CAV chemotherapy alone. Median survival for patients with extensive disease was 7.4 months. All patients with limited disease were still alive. Two relapsed patients with limited disease achieved significant response to VP-16/Cisplatin combination chemotherapy.
Fifty medical students were screened for hepatitis B serological markers of whom 42 students entered the study. Those who were found to be negative for all markers were vaccinated with 1.0 ml (20 mcg HBsAg) Engerix-B vaccine intramuscularly in the deltoid region according to the 0, 1, 6 month schedule. Blood samples were taken at 1, 2, 3, 6, 9 months. One month following the first dose, 7% showed detectable AntiHBs with a GMT of 11 IU/I. By the sixth month, just before the third dose was given, 79% seroconverted with a GMT of 2952 IU/I. Three months following the third dose all had seroconverted with a GMT of 18,381 IU/I. No serious adverse reactions were noted and none of the subjects showed evidence of hepatitis B infection during the study. This study thus confirms the high immunogenicity and safety of recombinant yeast-extract hepatitis B vaccine.
A prospective study was done to determine the incidence of cardiovascular malformations in neonates with Down's syndrome. 17/34 (50%) of the babies with Down's syndrome born at the Maternity Hospital, Kuala Lumpur, Malaysia had congenital heart defects. These included 7 cases of ventricular septal defect (VSD), 3 cases of patent ductus arteriosus (PDA), 2 cases of atrio-ventricular canal defect, 2 cases of ventricular septal defect with patent ductus arteriosus, 1 case of hypertrophic cardiomyopathy, 1 case of hypertrophic obstructive cardiomyopathy and 1 case of complex cyanotic heart. Only 8/17 (47%) of these babies had any clinical signs suggesting underlying cardiac defects. In view of the common occurrence of cardiac anomalies, it is recommended that echocardiographic screening should be carried out on all neonates with Down's syndrome.
Margosa Oil is an extract of the seed of the Neem tree and is widely used as a traditional medicine by Indians in India, Sri Lanka, Burma, Thailand, Malaysia and Indonesia. Used mainly for external applications, it is often administered orally to neonates and infants regularly in small amounts. Margosa Oil causes toxic encephalopathy particularly in infants and young children. The usual features are vomiting, drowsiness, tachypnea and recurrent generalised seizures. Leucocytosis and metabolic acidosis are significant laboratory findings. Management is aimed primarily towards the control of convulsions although supportive management is equally important. Prognosis is usually good but fatalities and neurological deficits have been reported. We report here two infants with Margosa Oil poisoning presenting with encephalopathy.
A validated study of the Self-Reporting Questionnaire (SRQ-20) of the World Health Organization against ICD-9 was found to have good validation indices at the cut-off point of 5/6. The sensitivity was 84.8% and specificity 83.7%. However, SRQ-24 had poor validation indices and are too sensitive to detect psychotic illness. Twenty-three per cent of 264 schizophrenic relatives who had been staying together with them and or actively involved in their care for at least one year had neurotic disorders compared with 1% who had latent schizophrenia. The prevalence of psychiatric morbidity was higher in the first-degree relatives compared with non-first degree relatives.
Pulmonary function parameters were examined in a Malay Muslim population during normal activity and Ramadan fasting conditions. The validity of employing various lung function prediction formulae for the subjects was also assessed. Present findings indicate that the water deprivation regime and resultant dehydration during Ramadan did not cause significant changes in ventilatory functions. Although pulmonary prediction formulae based on Caucasian and African populations were inapplicable to the subjects examined, the equations derived from the neighbouring populations in Singapore could be employed.
A study was carried out on 8,369 neonates delivered in the Maternity Hospital, Kuala Lumpur over a period of four months. Forty-nine neonates (5.6 per 1000 livebirths) had congenital talipes. The incidence of congenital talipes equinovarus (CTEV) was 4.5 per 1000 livebirths while that of congenital talipes calcaneovalgus (CTCV) was 1.3 per 1000 livebirths. 6/11 (54.5%) of the CTCV was unilateral, the ratio of right to left feet involvement being 1:1. Only 12/38 (31.5%) of the CTEV were unilateral, the ratio of right to left feet involvement being 1:2. Congenital talipes was significantly more common in the low birthweight neonates (p less than 0.001). However, the condition was not significantly more common in neonates with breech presentation nor in those born to primigravida mothers. Our data suggested that multifactorial genetic background as the most likely underlying cause of congenital talipes in Malaysian neonates.
A rare case of gestational trophoblastic disease (GTD) in a 54-year old Malay woman is described. A total abdominal hysterectomy with bilateral salphingo-oopherectomy was done. She was given methotrexate therapy as she had persistent high levels of serum B hCG.
A 44-year-old Indian housewife presented with prolonged cough, intermittent fever, loss of weight and shortness of breath on exertion. Physical examination revealed a thin lady with fine crackles on both lungs. Marked eosinophilia and elevated erythrocyte sedimentation rate were noted on peripheral blood. Chest radiograph showed characteristic bilateral infiltrates affecting the periphery of both lungs. Treatment with corticosteroid resulted in dramatic improvement in symptoms, signs and radiographic changes within a few days.
Impaction of food usually occurs in patients having obstructive lesions of the oesophagus. The food bolus impaction normally occurs in patients older than 60 years of age. Though food bolus impaction in the oesophagus is not uncommon, food bolus in the oesophagus causing complete obstruction resulting in total dysphagia is rare. This is a case report of a woman who had complete obstruction of the oesophagus following impaction by a piece of meat. The various treatment modalities available for such a condition are discussed.
The case of an elderly Chinese male opium addict with cauliflower ears is discussed. He had no history of contact sports that could have led to auricular trauma resulting in deformed ears. Besides cauliflower ears, he had features of chronic bronchitis. The association between opium addiction and cauliflower ears was first described way back in 1932. It was attributed to the prolonged opium induced sleep on hard surface subjecting the ears to repeated pressure and trauma. With the changing pattern of drug abuse, opium abuse related cauliflower ears will become a vanishing sign.
We describe the case of a 48 year old Indian female with hypercalcemia due to tuberculosis. She presented with symptoms of hypercalcemia and chest radiographs showed bilateral hilar lymphadenopathy with normal lung fields. The diagnosis of tuberculosis was made histologically from biopsy of the enlarged hilar nodes. Her hypercalcemia resolved following one month of anti-tuberculous treatment. The prevalence of hypercalcemia in tuberculosis has been reported to be high in western series. There is, however, a paucity of local data on the subject. The presence of 1-alpha-hydroxylase-like activity in pulmonary alveolar macrophages with resulting increased formation of active vitamin D metabolites is the postulated mechanism of tuberculosis associated hypercalcemia.
An interesting case of bifid blind-ending ureter occurring in a young Indian girl is reported. She presented with severe recurrent right iliac fossa pain for which she underwent appendicectomy which did not resolve her symptoms. Subsequent urological investigation--IVU and retrograde pyeleogram--revealed the genuine diagnosis. Surgical excision of the blind-ending branch was successful in relieving the intractable pain. A review of the literature on this uncommon congenital urological problem is outlined stating its clinical significance and treatment options.
The radiographs of fifteen Malaysian patients with presenting ameloblastoma aged between 20-55 years (average 35 years) were studied for any peculiar local features. The most common features were cortical plate expansion (80%), corticated scalloped margin (67%), multiloculation (87%), and resorption of tooth roots (47%). The latter two features are constantly found in advanced tumour stage. As pain was not a frequent complaint, many Malaysian patients seek treatment only at a very late stage after the tumours have reached large dimensions. Although ameloblastomas may be diagnosed often through radiographs, it should not be relied upon solely.
Hereditary spherocytosis is a rather uncommon disease in Malaysia as only 16 patients were seen in our hospital over a 13 year period. Pallor, jaundice and splenomegaly were common physical signs. Clinical severity of the disease was variable and more than half of them needed splenectomy. Complications including haemolytic crisis and cholelithiasis were encountered but not aplastic crisis. All 10 patients who underwent splenectomy had uniformly good results and none of them had post-operative complications.
The case histories of 22 patients with lung abscess and empyema presenting to Hospital University Sains Malaysia (HUSM) between 1984 and 1989 are reviewed. The presenting features of both lung abscess and empyema were similar. The commonest predisposing factor was pneumonia, and the commonest organism isolated was Staphylococcus aureus but in the majority of cases, no causal organisms were identified. All the patients were treated with antibiotics and in addition, closed chest tube drainage was performed initially in all patients with empyema. Three patients with empyema required additional surgical drainage procedures. Death occurred in one patient with empyema and in one patient with lung abscess. The features, aetiology, treatment and outcome of thoracic empyema and lung abscess are discussed.
Congenital branchial fistula and their embryology is well described in the literature. The accepted standard treatment method includes stepladder excision for extensive fistulas. This paper presents two cases (Case 1 and 2) which are embryologically typical of second and third arch origin respectively; and a third case (Case 3) which has not been previously described. Case 3 appears to be a hitherto unreported combination of first and second arch origin. Case 1 and 2 were treated via a standard stepladder excision approach. A different newer approach was utilised in Case 3, that is, stripping of the fistulous tract with Myer's vein stripper. Unlike the stepladder approach, this is simple and avoids extensive time consuming dissection. However, being a blind procedure, it is not generally advocated if vital structures exist in the proximity.
Sixty patients who received massive blood transfusion intraoperatively and/or in the immediate post-operative period were analysed. Six patients had hypokalemia and two had hyperkalemia. The multifactorial changes leading to electrolyte disturbances especially involving potassium are discussed in relation to hypotension, hypothermia, acidosis, pH, and release of catecholamine. Potassium changes in relation to anaesthesia are discussed. The danger of routine administration of calcium during massive blood transfusion is stressed.
Two hundred and ninety-three bronchoscopies were done for 285 patients (78% males, 22% females) at Hospital University Sains Malaysia between 1984 and 1988. The mean age was 56.4 years (range 13 to 90 years). 70.2% of patients underwent bronchoscopies to confirm or exclude the diagnosis of carcinoma of the bronchus, out of which 58% were confirmed to have bronchial carcinoma. 77% of the 98 patients with visible endobronchial tumours had biopsy specimens diagnostic of malignancy. Brushing and washing cytology increased the positive yield to 92%. The commonest histological type of bronchial carcinoma identified was squamous cell carcinoma (48.1%), followed by small cell carcinoma (27.1%), anaplastic/undifferentiated carcinoma (12.9%), adenocarcinoma (9.4%) and large cell carcinoma (2.4%). Bronchoscopy for the investigation of haemoptysis identified the commonest cause as 'bronchitis'. There were no complications noted in our series. Notable differences of our experience compared to that of the western series were the high percentage of bronchoscopy done for infective respiratory disorders and the younger age of our patients.