Tests of pulmonary function (FVC, FEV1, FEV 1%, and single breath CO diffusion), renal function (serum creatinine and BUN), liver function (serum ALT, AST, and ALKP) and a full haematological screen were performed on 27 paraquat spraymen (mean spraying time 5.3 years; mean individual annual quantity of paraquat handled, 67.2 kg as paraquat ion) and on two control groups. One of the control groups consisted of 24 general plantation workers with minimal exposure to paraquat arising from occasional work in recently sprayed areas, and the second consisted of 23 latex factory workers with no known occupational exposure to paraquat. The results showed no significant differences as a consequence of occupational exposure to paraquat. Long-term paraquat spraying at the concentrations used produced to quantifiable harmful effects on health as measured by the indices selected for this study.
Two hundred and twelve of undescended testes were operated on in the Department of Surgery, Singapore General Hospital between the years 1974 through 1980. There was a 51.9% incidence of right undescended testis, 34.9% left undescended testis and 13.2% were bilateral. The method of treatment was surgical exploration with orchidopexy wherever technically feasible or orchidectomy if the testis was found to be severely hypoplastic. Of the total series, 42% were operated on before the age of 5 years. The oldest patient undergoing orchidopery was aged 40. Failure of orchidopexy to secure the scrotal position for the testis was noted in 14 cases. This was probably due to inadequate mobilisation at the first operation. There was no mortality and no significant morbidity following surgical treatment in this series.
A case of apical hypertrophic cardiomyopathy occurring in a 53 year·old Indian man is described. So far only 39 cases have been reported in the english literature to the best of our knowledge. This case is the first reported in a non·Japanese and outside of Japan, suggesting that this condition may be encountered in future in other parts of the world.
A review of 20 cases of neuroblastoma at the University Hospital, Kuala Lumpur from 1967 to 1980 reveals six infants aged 2 to 13 months with stage IV·S disease, associated with an unusually good prognosis. Four of the six patients presented with hepatomegaly, one had skin nodules and another paresis of the lower limbs. The primary tumour was located infra-diaphragmatically in all cases, four had disease in the bone marrow but none had radiological evidence of bone involvement. Although not systematic, with limited treatment of low dose radiation and mild chemotherapy, four patients are alive and well, one absconded and one died of septicaemia. It is important to define this special category as an unexpectedly good survival is possible with minimal therapy. Death is more likely to result from over-zealous treatment than from the disease itself.
A study of race-related distribution of hepatitis B markers was conducted in 458 children admitted consecutively to Singapore General Hospital. The positive rates for hepatitis B surface antigen (HBsAg) in Chinese, Malays and Indians were 11.2, 8.0 and 12.2% respectively and the corresponding figures for anti-HBs were 30.2, 12.0 and 14.6%. In Chinese children HBsAg prevalence was shown to be sex-related, being higher in males than females. The percentages of Chinese children positive for anti-HBs and anti-HBc were also higher than those of the Indians. This study confirmed that Singapore children were exposed to hepatitis B infection from early life. All three races were equally susceptible to this infection.
The indirect fluorescence antibody technique has been employed to study the prevalence of toxoplasma antibodies in Singapore. 42.5% of clinically suspected cases of toxoplasmosis showed antibody titres. Of these, 17.5% had titres greater than or equal to 1.64. Malays and Indians have higher positive rates compared to the main ethnic group, the Chinese. Antibody titres are found in both males and females and span through the various age groups. The possible mode of transmission is discussed and the importance of congenital toxoplasmosis is indicated.
The Singapore Cancer Registry started operations on January 1, 1968. It is a population-based registry that seeks to obtain basic epidemiological and clinical data on all cases of cancer diagnosed in Singapore. The results presented pertain only to Singapore citizens and permanent residents and cover the period from 1973 to 1977. Of special interest are the cancer patterns of the main ethnic groups in Singapore. Generally, the Chinese (76% of total population) have significantly higher risks for cancer; the most prevalent sites are the nasopharynx, esophagus, stomach, liver, and lung. Within the Chinese group are also dialect group differences. The Malays (15% of population) have the lowest rates for most sites, whereas among the Indians (7% of population), mouth cancer is an important site for both sexes. All these variations provide useful clues in the search for etiological factors.
The history of efforts to establish a cancer registry in Malaysia since 1961 is reviewed. In 1980, the staff of the Institute for Medical Research in Kuala Lumpur was authorized to develop an official registry that would combine the resources of the various university faculties, the hospitals, research institutes, and the Cancer Society. Special registries operate for oral precancerous conditions and for nasopharyngeal carcinoma (NPC). The topics of recent epidemiological studies include: a review of all cancers diagnosed at the University Hospital during 1972-74, the association of Epstein-Barr virus and NPC, social and environmental factors associated with NPC, oral cancers, and childhood cancers.
Cleft lip and palate is the most common congenital abnormality seen in the Department of Plastic Surgery, Singapore General Hospital. A total of 461 operative cases seen over a period of 5 years (1977 to 1981) is analysed. There is a relatively high incidence in the Singapore population of 2.0 per 1000 live births. In both cleft lip and cleft palate deformities, there is no significant difference in the sex distribution. The cleft patterns show that 78% of the cases are unilateral clefts, 53% are left sided, 25% are right sided and 22% of the cases are bilateral clefts.
The birth weight distribution, mean birth weight and incidence of LBW amongst the various ethnic groups in Malaysia is described briefly. The data collected and analysed is hospital data where all deliveries in 1980 were analysed. The mean birth weight showed that the Chinese had the highest Mean Birth Weight amongst the three ethnic groups and the Indians had the lowest mean birth weights. The overall incidence of LBW was 11.8% and the Malay and Indian babies constituted the high
incidence of LBW whereas the Chinese had a low incidence of LBW babies in the study. Amongst the various ethnic groups the Indians had a higher incidence of LBW compared to the Chinese and Malays.
200 doctors are gazetted as practising in Sarawak in 1982. 88% are males and only 12% are females. Of the 200, 65.5% are Chinese and the natives of Sarawak and Indians form 15.5% each. Nearly 30% are graduates from local universities, 44% from universities in Commonwealth countries and a few from universities in other countries. The majority of the doctors are under 40 years of age. 55 % are in government service, while 45% are in the private sector. All private practices are solo practices except three-one each in Kuching, Sibu and Miri which are based on partnership. The number of doctors with specialist qualifications is not known as it is not essential for these qualifications to be entered in the Register. The doctor-to-population ratio in Sarawak has improved from 1:14000 in 1964 to 1:6856 in 1982. To reach the Ministry of Health's target of 1:2500 by 1990, a yearly recruitment of 58 doctors would be needed from 1983 to 1990. This would be feasible if either an admission quota to the local medical faculties for Sarawakians is implemented or more doctors are posted to serve in Sarawak.
The evidence for a hypothesis that eating salted fish is associated with nasopharyngeal carcinoma (NPC) is reviewed. The hypothesis was tested among Malaysian Chinese using a matched case-control design. The kinds of salted fish and patterns of use were also investigated in a control group comprising 100 Chinese, 50 Malay and 50 Indian households. During 1980, in Selangor, Malaysia, interviews with 100 Chinese cases of NPC and 100 non-disease controls indicated that salted fish consumption during childhood was a significant risk (relative risk = 3.0, P = 0.04), with an elevated risk for daily as opposed to less frequent consumption. Salted fish consumption during adolescence was a less significant risk, and current consumption not at all. There were 19 kinds of fishes reported as being eaten as salted fish by the 200 control households. There were marked differences between ethnic groups in preference for different kinds: Chinese preferred red snapper (74% of households), Malay jewfish (54%) and Indian red snapper (28%). Salted fish was hardly ever eaten daily by any household; weekly was a moderate frequency in all ethnic groups; less than weekly most common. There were no statistically significant differences between Chinese NPC case and non-disease control participants in kind of salted fish eaten. Results were the same when the data were analyzed by sex, subethnic group and income.
The transcutaneous (Tc) bilirubinometer was evaluated in 105 jaundiced neonates, comprising 38 Malays, 37 Chinese and 30 Indians, who had not been treated with phototherapy or exchange transfusion. Tc bilirubin index and serum bilirubin concentration correlated at statistically significant levels in all the three racial groups. Unlike the Chinese and Malay babies, the action levels, using Tc bilirubin index, in the Indian babies are not reliable due to the wide variation of skin pigmentation. Neonatal jaundice is conventionally monitored by estimation of serum bilirubin level. This involves blood sampling. The transcutaneous (Tc) bilirubinometer, however, is non-invasive, small and portable. In this study, the use of the Tc bilirubinometer in the management of neonatal jaundice' in the three racial groups was evaluated.
Accidental organophosphate poisoning may occur in persons coming in close contact with animals being treated toitb organophosphate pesticides. The poisoning may manifest itself as a severe systemic disorder, but can be diagnosed by an alert physician and confirmed by specific tests of reduced cholinesterase activity in the blood, plasma and red blood cells. Treatment is with intravenous atropine. Supportive measures may be necessary.
This study reviews experiences in the management of three cases of lacerations of the vagina following coitus. A brief review of the recent literature is made. Although the extent of injuries can be very variable, the principles of management consist of prompt
resuscitation and arrest of haemorrhage, appropriate surgical repair under general anaesthesia, and systemic or local antibiotic therapy to combat infection. Avoidance of vigorous or abnormal coital practices, especially in single women, in the immediate postpartum period, and in postmenopausal women, can help to reduce the frequency and severity of such injuries.
A review of our experience of 916 cases ofpartial bilateral vasectomy performed under local anaesthesia at the University Hospital, Kuala Lumpur during the
period between January 1971 and June 1980 is presented. Minor post-operative complications occurred in 5.8% of cases with a low post-operative infection rate of 1.2%. In 35% ofpatients, persistence of non-motile sperms in the semen were seen after at least ten ejaculations in each instance. In four of these cases non-motile sperms continued to persist into the sixth month of follow-up even after at least 50 ejaculations in each instance.