Damage to the lower ureters during pelvic surgery is a serious and well-recognised complication. This iatrogenic injury, when undetected intra-operatively, continues to give rise to significant patient morbidity. In 1987, this Department was referred 18 cases of iatrogenic ureteric injuries. 16 patients were from gynaecologic surgery and 2 patients were from general surgery. Only 4 cases (24%) were detected and referred intra-operatively. 13 patients presented post-operatively with various symptoms viz., anuria, loin pain and urinary leak per vagina. Good recovery of urinary function was achieved in all cases after urological intervention, usually by ureteric re-implantation.
Two cases of girls seen in Sarawak with the diagnosis of Rett Syndrome are reported. Their ages were 6 and 2 years respectively at the time of the report. Diagnosis is made clinically as there is as yet no scientific marker. Specific diagnostic criteria were met. There was a history of slowing of development followed by loss of previously acquired skills, changes in emotional development and behaviour and the definite emergency of stereotyped behaviour especially hand wringing in both girls. Onset was early in both girls, around nine months. Both girls are profoundly retarded mentally but the regression appeared to be static at present.
This paper reviews our first 100 consecutive PTCAs done between December 1988 and May 1990. There were 31 females and 69 males and their ages ranged from 37 years to 80 years. The mean age was 57.7 years. We achieved a follow-up rate of 66%. The restenosis rate was 22% of those that we could follow-up. There were 35 simple and 65 complex PTCAs. An average of 1.39 arteries were entered per PTCA. Of the 100 PTCAs done there was a primary success rate of 83%. On closer examination most of the failures were in the total occlusion group. There were 30 total occlusions done and 17 were successfully dilated. The primary success rate for acute total occlusions was 77% and the primary success rate for chronic total occlusions was 41%. Of the 100 PTCAs there were two deaths and only one patient had to go for emergency bypass surgery. The other complications were relatively minor including hypotension, groin bleeding, chills and rigors. This paper documents our initial 100 cases of PTCAs. It shows that our figures are compatible with other centres in this region and those around the world.
Two cases of ovarian hyperstimulation syndrome (OHSS) following the GIFT procedure are reported. This article highlights the potential dangers of this condition and discusses the classification and management.
We describe a fatal case of paraquat poisoning as a result of per vaginal contact with the herbicide. Death occurred 18 days later from hepatic, renal and respiratory failure.
Over a seven month period in 1986, 164 (1.1%) of a total 15,131 neonates delivered in the Maternity Hospital, Kuala Lumpur were born to mothers with prolonged rupture of the fetal membranes. Septic work-ups were performed on 163 of these babies shortly after birth, 77 of them had no bacteriological, radiological or other clinical evidence of infection. The remaining 86 had additional history of illness. Nine of these 86 babies had proven infection: four with septicemia, one with meningitis and four others with congenital pneumonia. This study showed that neonates had risk of infection only when maternal history of prolonged rupture of the fetal membranes was associated with other clinical evidence of infection. However, even in this group of neonates at risk, 89.5% of them were not infected. Therefore, there is still a need to develop a simple, rapid, reliable and cheap laboratory method to help early identification of the infected from the non-infected neonates in order to prevent unnecessary antibiotic treatment and hospital stay.
A review of patients with diphtheria seen in the Paediatric Unit, Alor Star General Hospital, from January 1985-March 1987 is reported. Their clinical presentation, diagnosis, treatment and outcome were analysed and discussed. Clinical awareness regarding the diagnosis of diphtheria is emphasised.
Tuberculosis of the thyroid gland is a rare condition. A case of tuberculosis of the thyroid gland presenting as a solitary thyroid nodule is presented. Management is operative intervention and anti-tuberculous chemotherapy. The final diagnosis is made after histopathological confirmation of the typical appearances.
This article is an analysis of seven patients who presented to the Gynaecology Unit, General Hospital, Ipoh, during the period 1984-1985 with vaginal injury sustained during normal coitus.
Four patients were between 22-34 years of age. The remaining three were in the 51-64 year group; all the three had undergone previous gynaecological surgery.
History of coitus as the precipitating cause was elicited in all our patients and having reached a diagnosis, subsequent management was fairly straightforward. Two patients presented with clinical features of haemorrhagic shock and required initial resuscitation with blood transfusion. Five patients required definitive surgical repair of the vaginal injuries, and in only two patients was conservative management possible. Both these patients were in the menopausal age group.
Study site: Hospital Ipoh, Perak, Malaysia
A review of the home haemodialysis programme at the General Hospital, Kuala Lumpur between 1977 and 1984 revealed that out of 194 patients accepted into the programme, 187 completed home training and continued haemodialysis at home, seven died before having started on the training programme. The majority of patients required less than four months to be trained; 107 patients performed dialysis independently and 24 required assistance only for the insertion of needles. Patient survival was 93%, 80% and 69% at one, three and five years, respectively. Rehabilitation has been excellent and few social problems were encountered. Our experiences with home haemodialysis have shown that the majority of patients were able to assume responsibility for their own dialysis, and this has contributed to the good survival and excellent rehabilitation. Home haemodialysis was started in Boston in 1963, in Seattle and London in 1964 for the treatment of end stage renal disease (ESRD). It is now well-established as a therapy for patients with ESRD. Home haemodialysis has been practised in Malaysia since 1977. This report reviews the experiences of patients accepted for treatment between 1977 and 1984. All patients were treated by the Department of Nephrology, General Hospital, Kuala Lumpur, which supervises patients living all over the country.
50 cases of anterior chamber intraocular lens implantation at the University Hospital, Kuala Lumpur were studied. 80% of the cases achieved visual acuity of 6/9 or better. The percentage would be higher if cases with pre-existing pathology are excluded and the period of follow-up is longer. Complications, mainly minor and non sight-threatening, are discussed.
A patient with a left atrial myxoma is reported to illustrate the value of two dimensional real time echocardiography in the diagnosis of intracavitary cardiac tumours.
The present study reports on a successful treatment of a single case of obsessive compulsive neurosis using a behavioural technique, namely, systematic desensitisation. Much recent literature has suggested that behavioural techniques may be more helpful with this particularly difficult condition than traditional methods of treatment, such as medication. The present results suggest that the technique of systematic desensitisation may be successfully used in a non-western setting.
Two series of Blood Pressure (BP) measurements were carried out to assess the variability in BP following repeated measurements in normotensive individuals. In one series, measurement of BP on three occasions three and seven days apart revealed a significant drop in BP in unaccustomed subjects ('untrained'). In a second series assessing the significance of time-interval between measurements or the number of measurements, it was found that a significant fall in BP occurred over the first four days in 'untrained' individuals, whose blood pressure was measured repeatedly for five consecutive days. A significant positive correlation was evident between the falls in systolic and diastolic pressures and the pressure at first screening. Assessment of the anxiety status revealed a significantly lower state anxiety in 'trained' subjects. It therefore appears that (a) BP in normotensive individuals previously unaccustomed to BP measurements, drops significantly with repeated measurements, (b) the number of measurements seem more important than the time-interval between measurements, (c) the largest falls occur in individuals with high initial pressures and (d) the fall upon repeated measurements may be due to reduced anxiety as familiarity with the procedure makes the subjects comparatively relaxed and less state anxious.