The aim of this study was to investigate the attitudes and desire of Malaysian patients for information about anaesthesia and compare the result to that of other similar studies in other countries namely Scotland, Canada, Australia and denMark. Two hundred and forty patients undergoing elective surgery were asked to complete a preoperative quentionnaire examining their desire for information relating to anaesthesia. As in all countries compared, most Malaysian patients were interested to know the time they could start to mobilize from the bed and the time to commence normal oral intake postoperatively. Information related to postoperative pain and pain relief was also highly desired. However, patients showed less interest towards information about perioperative anaesthetic or surgical procedures and drug used. Unlike Australian patients, the Malaysian patients showed less interest about perioperative complications. As in other countries, patients under the age of 50 years had a greater desire for information than those who were older. However there was no difference in desire for information between male and female patients. Patients who have had previous anaesthesia would ask more information compared to those who had none.
The aim of this study was to determine the effects of palm oil-derived vitamin E on glucocorticoid-induced osteoporosis. Three-month old male Wistar rats were adrenalectomised to remove circulating glucocorticoids. The animals were then administered with Dexamethasone 120 µg/kg body weight/day. Treatment with palm vitamin E 60 mg/kg body weight/day was given simultaneously. The results showed that palm vitamin E prevented the loss in regional and whole body bone mineral density seen in the Dexamethasone treated animals. Palm vitamin E improved femoral length and calcium content in the Dexamethasone treated animals. The results confirmed that palm oil-derived vitamin E was effective in preventing glucocorticoid-induced osteoporosis.
Borderline epithelial tumours or low malignant potential epithelial tumours of ovary have a better prognosis and hence it is important to distinguish this group from their malignant counterparts. Several studies were done correlate the growth rates of tumours with nuclear proteins that are expressed in proliferating cells. Immunohistochemical stains with monoclonal antibodies against proliferating cell nuclear antigen (PCNA) were used on 51 archival epithelial tumours of ovary. The percentage of PCNA reactivity showed means of 1.1%, 2.3% and 27.7% with benign, borderline tumours and malignant epithelial tumours of ovary. respectively. The % PCNA reactivity was found to be significantly different amongst the three group (p<0.001). Thus , PCNA reactivity can help to differentiate borderline tumours from malignant epithelial tumours of ovary. This is critical when light microscopic appearances are equivocal and therapeutic management is dependent on the diagnosis.
Bleeding is a serious complication of peptic ulcer and mortality rate has remained at approximately 10% or more. Traditionally surgeons selected patients who were at significant risk of continued or re-bleeding and advocated early surgery. However, patients with bleeding peptic ulcers are generally elderly with coexisting medical illness and surgery results in significant morbidity and mortality. In the last decade, endoscopic haemostatic therapy has been effective in arresting the bleeding with surgical option considered only after endoscopic treatment has failed. We report the outcome of 196 patients who were endoscopically diagnosed to have bleeding from peptic ulcers. One hundred and thirty patients were to have active bleeding or recent bleed from the ulcer. Endoscopic adrenaline injection therapy was used in 53 patients who had active bleeding ulcers and another 77 patients with endoscopic evidence of recent bleed. The injection therapy was successfully in 127 (97.7%) patients. The treatment failed in three patients and they underwent urgent surgery. Re-bleeding occurred in 26 (20.5%) patients and endoscopic adrenaline therapy was repeated in these cases. Haemostatic was achieved in 19 patients, however 7 patients continued to bleed and required surgery. There were 3 deaths, principally from advanced age and coexisting medical illness. Endoscopic therapy for bleeding peptic ulcers is simply to apply, safe and effective. In cases of re-bleeding after initial endoscopic hemostasis, re-treatment is a preferable alternative to surgery. The role of surgery is limited to bleeding that is refractory or inaccessible to endoscopic control.
"Cauliflower Ears" describes the appearance of swelling of the auricular cartilage resulting in gross distortion of the auricle. The underlying pathology is inflammation of the auricular cartilage. We report a case of a patient who presented to the ophthalmology clinic with an ocular inflammation, whose subsequent diagnosis of replapsing polychondritis was clinched with the finding of "Cauliflower Ears". This case emphasizes the importance of an appropriate general examination of ophthalmic patients for early diagnosis and prompt institution of medical treatment, which may prevent life-threatening complications to the patient.
Study site: Eye clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
A patient who presented with massive upper gastrointestinal hemorrhage underwent a Billroth II partial gastrectomy. He developed efferent loop obstruction due to a retained abdominal drain. Relaparotomy for removal of drain was performed. Retained drains are known complications but rarely, it is cause of efferent loop obstruction.
Metformin Associated Lactic Acidosis (MALA) is a rare, but serious complications of Type 2 diabetes mellitus treatment with a mortality rate of around 50%. It most commonly occurs in the setting of hepatic, cardiac or renal insufficiency. We report the case of an elderly female with MALA and concomitant starvation ketosis in the absence of any known risk factor, who went undiagnosed for a period of at least a month and made a complete recovery in the hospital.
Fourteen fit and healthy patients underwent arthroscopic subacromial decompression (ASD) of shoulder for rotator cuff impingement. Their blood chemistry was analysed pre-operatively, 24 hours post-operatively and 2-3 weeks post-operatively. Levels of haematocrit, sodium, potassium, creatinine and urea were measured. The blood chemistry returned almost to the pre-operative level at 2-3 weeks post-operatively. There was no statistically significant differences found. This study concludes that arthroscopic subacromial decompression is a safe technique when considering the blood parameters despite the haemodilution seen in all patients.
The author reports a case of a 11-year old child presented with peroneal nerve entrapment secondary to proximal fibular osteochondroma, with complete recovery of function following the excision of the tumor.
Ewing's sarcoma is a rare malignant tumor of the foot in children. We report a case of Ewing's sarcoma of the talus in a four-year-old Chinese girl to highlight the initial difficulty in diagnosis and the clinical course of the disease. She was initially diagnosed as osteomyelitis of the talus and died eight months after presentation with pleural and spinal metastases. To the best of our knowledge, Ewing's sarcoma of the talus in a young child has never been reported in Malaysia.
Neurological deficit after surgery for spinal deformity is a rare but devastating complication. Factors that have been associated with a post surgical deficit are congenital curves, large curves, kyphotic deformities, anterior and posterior surgery, ligation of multiple anterior vessels and hypotension; controlled or otherwise. Intra operative wake up tests have been used alone or in combination with spinal cord monitoring: to detect evolving neurological deficit in spinal deformity surgery. Despite these checks, major neurological deficits still occur post surgery. This is a report of two cases with normal intra operative wake up tests, but developed neurological deficit twelve hours after the end of surgery.
The Government's decision to drastically and speedily increase the number of doctors in the country needs to be reviewed. The standard and quality of health care does not depend on the number of doctors, but on the improvement of the health care infrastructure. Increasing the number of government medical schools and increasing the intake of students should be done on a need-to basis, with the above perspective in mind. The selection criteria of candidates must not be compromised and the teaching staff must be adequate and experienced. The number of doctors should be gradually increased over the years in tandem with the development of the health care infrastructure and the deployment of doctors must be directed at providing equitable care to the people at all economic levels and geographic locations. The strength of academic staff in existing government medical schools must be upgraded to provide high level of teaching and research, perhaps reinforced with the recruitment of suitably qualified and experienced foreign teachers. The infrastructure of existing government medical schools must be upgraded to cater for the gradual increasing demand for more doctors as the country develops. The selection of candidates for the government medical schools must be based on merit and without undue emphasis on ethnic considerations, for it is only in the arena of fair competitiveness that excellence can be born. The considerations of merit in selection must include assessment of attitude, self-development, moral ethics and reasoning. If the above perspectives are fully appreciated, then there is really no requirement for private medical colleges in Malaysia.
To answer the question posed the terms of reference of local ethical committees as well as a few from overseas were reviewed. It was noted that these committees were established by various professional bodies and functioned independently. Guidelines for ethical practice and conduct were made available to the profession with compliance left to the individual doctor. Amongst the many ethical issues of concern both to the public and the profession was that of self regulation. It is being suggested that these concerns be addressed rather then set up a national body.