We report a case of keratoacanthoma in a non-sun-exposed nasal vestibule of an 84-year-old man. He presented with a progressively growing left nasal mass that had been present for 8 months. Examination showed a non-tender protruding mass arising from medial vestibular wall of the left nostril. Histopathology indicated it was a keratoacanthoma. In an elderly patient with a history of a progressively growing mass in the nose, a differential diagnosis of malignancy should be ruled out, and histological conformation is essential. To our knowledge, only a very small number of cases of nasal vestibular keratoacanthoma have been reported.
Elder abuse is a pervasive phenomenon around the world with devastating effects on the victims. Although it is not a new phenomenon, interest in examining elder abuse is relatively new. This paper aims to provide an overview of the aetiological theories and measures of elder abuse. The paper briefly reviews theories to explain causes of elder abuse and then discusses the most commonly used measures of elder abuse. Based on the reviewed theories, it can be concluded that elder abuse is a multifactorial problem that may affect elderly people from different backgrounds and involve a wide variety of potential perpetrators, including caregivers, adult children, and partners. The review of existing measurement instruments notes that many different screening and assessment instruments have been developed to identify elders who are at risk for or are victims of abuse. However, there is a real need for more measurements of elder abuse, as the current instruments are limited in scope.
It is known that many older people have difficulties in performing daily living activities such as cooking. These are due to the demands of the tasks and the changes in functional capabilities of the older people. This study examines cooking tasks performed by the aged that includes preparing and cooking meals, and storing kitchen tools in the kitchen. The objectives are to investigate the cooking difficulties encounter by older people and the safety concerning cooking tasks. This study focuses on individuals of age 65 years and above who can cook for themselves and/or family. Data were collected through observation, interviews, questionnaires and role play methods. The findings revealed that the common problems were due to the awkward body position where subjects had to bend down to take things from lower shelves, taking/storing things on higher shelves and cleaning the cooker. Moreover, the safety concerns were the layout of work centres (storage, cooker and sink), the use of cooker and opening packaging. It can be concluded that cooking difficulties are caused by inappropriate kitchen design and the decline of functional capabilities in older people.
In this retrospective study, 81 patients were diagnosed to have deep vein thrombosis (DVT) at the University Hospital, Kuala Lumpur over a ten year period from 1977 to 1986. Fifty-six patients had their DVT confirmed by venograms. The left side was affected in 79.5% of venographically proven cases of DVT of the lower limbs above the popliteal vein. The incidence of clinically apparent DVT following surgery was 0.21 per 1,000 operations. The incidence of pregnancy-related DVT was 0.039%. DVT was 3 times more frequent in the puerperium than in the antenatal period. The overall incidence of symptomatic pulmonary embolism was 13.6% of the cases of DVT.
Raised intraocular pressure (lOP) is generally held responsible for causing visual loss in chronic simple glaucoma. It is therefore desirable that a safe level of lOP be maintained all the time. Elevation of lOP with change of body position has been suggested as one of the factors which result in tissue damage in low tension as well as in primary wide open angle glaucoma. Postural behaviour of lOP was therefore studied in 58 normal and 30 glaucomatous Malaysian eyes. Clinical significance and possible pathogenesis of abnormal postural response of lOP has been discussed. More application of this simple procedure is advocated.
The ultrasound findings of 100 patients with chloedocholithiasis documented by cholangiography and/or surgery were reviewed retrospectively. Common duct stones were detected in 45% of patients. This detection rate which is comparable with most series confirmed the lack of reliability of ultrasound in the diagnosis of choledocholithiasis. All the stones detected were in dilated common ducts. The main limiting factor was overlying bowel gas which impair visualisation of the lower part of the common duct. Despite the apparent insensitivity of ultrasound to detect common duct stones, the modality is still a valuable non-invasive screening diagnostic tool, because in positive cases, patients may be spared from invasive cholangiographic procedures.
Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeons faced with this problem. Two such cases and their outcome are presented. The first case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. The second case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. Both patients died for reasons unrelated to the pneumoperitoneum. The passage of air from the chest cavity into the abdominal cavity was along the great vessels in the first case and through the diaphragm in the second. A compilation of other aetiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest visceral perforation, an abdominal tap or lavage should be attempted. If negative, continued observation is advised.
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.
This study aims to investigate the incidence and causes of hyponatraemia in hospitalised elderly patients. There was a total of 407 new patients. 55 (13.5%) patients were found to have at least one episode of hyponatraemia during their hospitalization. There were 58 deaths. Fifteen out of 55 (27.3%) patients who had hyponatraemia died compared to 43 out of 352 (12.2%) normonatraemic patients (chi-square significant, p < 0.01). The three most common causes of hyponatraemia were syndrome of inappropriate antidiuretic hormone secretion (SIADH), poor oral intake and diuretics. The two most common causes of SIADH were lower respiratory tract infection and stroke.
A previously healthy 80-year-old woman presented with a history of a thorn prick injury over the
distal phalange of her left finger obtained while gardening two months ago. She claimed to have a
non-healing cut with a nodular lesion, which progressively increased in size, extending upwards
towards the region of her left arm. There was no fever or palpable lymph nodes in the axillary region.
She had been prescribed antibiotics from the local hospital but her condition did not improve.
Xanthomatous changes can be observed in various conditions including primary xanthomatosis that is linked to an underlying hypercholesterolemia and more commonly associated with secondary xanthomatous degenerative processes in neoplasm and chronic inflammation. Meningioma with extensive xanthomatous change is exceedingly rare. The presence of cholesterol clefts within this peculiar meningioma subtype has not been described. Herein, we report an unusual case of xanthomatous meningioma in an 83-year-old normolipidemic woman, who presented to us with worsening lower limb weakness and global aphasia. There was increasing evidence to suggest that the presence of xanthomatous changes in long-standing meningioma is merely a sequela of cellular degeneration rather than true metaplastic change as previously hypothesized. Hence, the diagnosis of "xanthomatous meningioma" in the metaplastic category should be revisited and considered as a distinct histological subtype. The possible histogenesis of such intriguing phenomenon is discussed with a review of the literature.
Suicidal feelings and a sense of hopelessness have been regarded as part of the ageing process more so in the context of being elderly and having physical difficulties. As older adults are the fastest growing population in the world, suicides among this population is also expected to increase. The authors retrospectively reviewed all cases recorded by the National Suicide Registry Malaysia (NSRM) for the year 2009. Suicide in victims 65 years and older totaled 23 in number and accounted for 7.1% of all suicides. All the cases were autopsied. The case records were retrospectively analyzed with respect to age, gender, ethnicity and method of death. Comparisons were also made between males and females, levels of education, presence of stressor and life events antecedent to suicide. The ages of these suicide victims ranged from 65 to 94 years. Men comprised almost 70% of the cases. The average age of the victim was 73 years. Hanging was the most common method of suicide, accounting for 56.5% of the cases. Other methods included jumping from height (13.1%), exposure to unspecified chemicals (13.1% ), jumping/lying before moving object (4.3%), exposure to pesticides (4.3%) and injuring oneself using sharp object (4.3%). Death of a loved one, legal problems, financial problems and physical illness were the stressors identified contributing to the suicide act.
This study was conducted to describe corneal endothelial cell density and morphology in Malay eyes. Non-contact specular microscopy was performed in 125 eyes of 125 Malay volunteers, aged 20-87 years. Studied parameters included endothelial cell density (CD), mean cell area (MCA), coefficient of variation (CV) in cell area, as well as hexagonal appearance of the cells. Mean endothelial cell density in the study population was 2648 +/- 310 cell/mm(2). Mean CA, CV and percentage of hexagonal cells were 382.8 +/- 47.7microm(2), 58.1 +/- 22.6, 44.3% +/- 11.5% respectively. There was a statistically significant decrease in endothelial cell density (correlation - 0.300, P = 0.001) and CV in cell size (correlation - 0.208, P = 0.02) with age. There was a statistically significant increase in mean cell area (correlation 0.300, P = 0.001) with increasing age. The correlation between age and percentage of hexagonal cells was insignificant (correlation 0.074, P = 0.41). In conclusion, a consistent decrease was noted in the endothelial cell density with increasing age. The differences in endothelial cell density between genders were statistically insignificant.
Colorectal carcinogenesis is a complex multistep process that includes changes in histomorphological appearance of the colonic mucosa and changes at molecular level. Aberrant crypt foci (ACF) was first described by Bird in 1987 on examination of methylene-blue-stained colonic mucosa of azoxymethane-treated mice under light microscopy. Since then ACF was considered as the earliest preneoplastic change that can be seen in the colonic mucosa. The aim of this study was to look at the histomorphology and distribution of ACF in colorectal carcinoma. 50 formalin-fixed archival colectomy specimens for colorectal carcinoma were examined under light microscopy after staining with 0.2% methylene blue. ACF was identified by larger and darker crypts with thickened epithelium, and often elevated from adjacent normal mucosa. ACF was found in 41 of 50 colectomy specimens examined. There were 328 ACF consisting of 36 (11.0%) ACF without hyperplasia or dysplasia, 263 (80.2%) ACF with hyperplasia and 29 (8.8%) ACF with dysplasia. Of these 29 ACF with dysplasia, 25 showed low grade dysplasia and four high grade dysplasia. The density of ACF was higher in the left colon, those older than 65 years of age and among males but these findings were statistically not significant. The crypt multiplicity of hyperplastic ACF (30.149, SD 28.395) was larger than dysplastic ACF (20.613, SD 40.128). The spectrum of histological changes observed probably represent the evolution of ACF in colorectal carcinogenesis.
BACKGROUND: Industrial hand injuries are a common occurrence and contributes to a large segment of workers' morbidity. The main aim of this study was to look into the day pattern, types and location of upper limbs injures, identify the types of machines involved and highlight the treatment received.
MATERIALS AND METHODS: The present study was performed on 57 industrial workers admitted and treated by the Orthopaedic team of Universiti Kebangsaan Malaysia Medical Centre (UKMMC) for acute injuries sustained whilst working.
RESULTS: The majority of the workers were male (93%). The commonest age group involved was between 25-35 years (48%). The right hand was injured more then the left with majority of injuries involving the fingers. Interestingly, we also observed that injuries occurred more on Saturdays. Laceration was the most common injury followed by fractures and crush injuries. Treatment depends on the type and severity of injuries. For most lacerated wounds, treatment was debridement, primary suturing and antibiotic therapy. Injuries on Saturdays indicated that workers needed a longer time break especially during weekends after a long hectic week.
CONCLUSIONS: Injuries sustained by workers may be prevented by proper working techniques and conditions together with wearing of protective gadgets.
Study site: Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Urut Melayu, the traditional Malay massage, had been introduced into three pioneer hospitals in Malaysia, as part of the integrated hospital program. It was introduced primarily for the rehabilitation of poststroke patients. After almost 3 years since it was first implemented, there are currently plans to extend it to other hospitals in the country. Information from this study will contribute toward a better future implementation plan.