Forty children treated non-operatively for fractures of the femoral shaft were reviewed with regard to differences in limb length after treatment. Follow up duration ranged from two to seven years. The average femoral overgrowth was 0.85cm (range 0 - 2.5cm) and was influenced by age at the time of fracture. We were not able to find any association between the quantity of overgrowth and race, gender, level or configuration of the fracture.
This is a case of a posterior mediastinal mass in an asymptomatic gentleman, which was resected successfully and he has been disease free for more than a year of follow up. The histopathology findings happen to be a rare occurrence.
"This note reports the experience of an attempt to find and re-interview in late 1988 and early 1989, as part of the Second Malaysian Family Life Survey (MFLS-2), the female respondents to the 1976-77 Malaysian Family Life Survey (MFLS-1) and a sample of their adult children aged 18 or older.... We discuss the field methods used to track the panel members and their adult children, report follow-up rates and analyze the selectivity of attrition from the panel, using data from the MFLS-1 on characteristics of both the missing and the re-interviewed respondents and their families. We then discuss the degree to which these results might be generalized to other such attempts at re-contacting survey respondents."
An appraisal of the regional reconnaissance geophysical, geochemical and geological data obtained under the Central Belt Project in 1977 – 1978 appeared to constitute favourable uranium exploration targets. Follow-up surveys conducted until the year 1990 have proposed the exploration area to be divided into three transects. Transect 1 covers the western part of the state of Kelantan, northwest Pahang and the eastern half of Perak. Transect 2 covers southeastern tip of Perak, west Pahang, eastern half of Wilayah Persekutuan, eastern portion of Selangor, and the northwest portion of Negeri Sembilan. Transect 3 covers central Kelantan, northwestern of Terengganu and northern portion of Pahang. Results of the study indicate that the Main Range, Bujang Melaka, and Bukit Tinggi Plutons are most fertile with uranium spectrometric rock values range from 13 to 25 ppm. Further investigations to zero down the target areas for uranium mineralization are strongly recommended over these areas.
Synovial sarcoma of the extremities is an uncommon type of soft tissue sarcoma occuring predominantly in young adults at the para-articular regions. We present a series of 10 patients with an average age of 44 years and include a follow-up of 39 months. Eight patients had a surgical procedure for a mistaken benign lesion. In contrast to other soft tissue sarcomas, the swellings were associated with pain and most were fixed to the underlying structures. Five patients had a local reccurence after many years, stressing the necessity for close and long-term follow-up in these patients.
Calcinosis cutis is a rare presentation and not many cases have been reported especially of idiopathic type. We are reporting a case of idiopathic calcinosis cutis of lower limbs in a 33-year old female who presented to our clinic for multiple painless swellings over her lower limbs for the past six months, without any history of trauma or infection. We have decided to observe her condition on regular follow-up and conservative management.
The principle of ferrule effect is of prime importance when restoring an endodontically treated tooth. A severely broken down tooth due to subgingival caries almost always end up with extraction as inadequate ferrule effect would compromise the predictability of restorative treatment. This clinical case report describes a treatment approach that combines non-surgical endodontic treatment, orthodontic extrusion and prosthetic rehabilitation to restore the function and aesthetic aspect of an extensively carious premolar with compromised prognosis. One year follow-up indicated stable periodontal health with evidence of periapical healing radiographically.
Limb lengthening of fibular hemimelia is associated with progressive ankle valgus deformity. We reported a successful tibial lengthening in fibular hemimelia without recurrence of ankle valgus in 2 cases. The procedure involved 2 stages. First stage was a resection of the fibular remnant followed by a bending osteotomy through the distal tibial physis before the age of 2 years old. The second stage was a tibia lengthening up to 25% of its original segmental length performed at the age of 5 years old. There was neither progressive ankle valgus nor distal tibial growth arrest observed at 4 years follow-up.
Ventricular tachycardia (VT) storm is an uncommon but life-threatening condition. We describe the incidence, causes and management of VT storm among patients admitted to the coronary care unit of a large tertiary hospital.
A patient with Mycobacterium abscessus lung disease was mistaken to have pulmonary tuberculosis with airway colonization by the non-tuberculous mycobacterium. Appropriate antibiotics were only given when the patient's signs and symptoms worsened while on anti-tuberculosis therapy. Despite treatment with a combination of antibiotics showing in vitro susceptibility, the pathogen persisted in the respiratory secretions for longer than 6 months and the patient suffered a spontaneous pneumothorax 14 months into treatment. This case illustrates the chronic course of M. abscessus lung infection, the tendency for flare-ups, the inadequacy of current treatment regimens, and the necessity for prolonged patient follow-up.
Ossifying fibromyxoid tumor (OFMT) is a rare benign tumor, most of which occurs in adults with localization in the subcutaneous tissue or muscle of the extremities. A five-year-old girl presented with a mass in her right upper thigh. Due to the large size of the mass (10 x 7 cm), our provisional diagnosis was a soft tissue sarcoma. A tru-cut biopsy showed that the lesion was benign. The mass was excised and has not recurred since. To the best of our knowledge, this patient is the youngest case of OFMT reported in the English literature.
Retrospective analysis was done on 235 recipients, 133 males and 102 females, who were transplanted between 25th September 1979 and 25th June 1999. 85.1% were Chinese, 7.7% were Indians and 7.2% Malays. 23% (54) were living related renal transplants (LRRT) all except 5 done at Hospital Kuala Lumpur. 60% (141) were living unrelated donor renal transplants (LURT) done in India. 17% (40) were cadaveric transplants (CADT) (all done in China except 2 at Hospital Kuala Lumpur and one in London). 97% (228) were first transplants. Primary renal disease was unknown in 69.4%, 17% (40) glomerulonephritis, 5.5% diabetic nephropathy and 8.1% 19 others. All were on prednisolone, 93.2% were on azathioprine and 96.6% were on cyclosporin A. The acute rejection rate was 23.4% (55 episodes). Patient survival was 88% at five years and patients alive with functioning graft was 84% at 5 years. LRRT had significantly better survival compared to LURT. 34 grafts were lost to chronic allograft nephropathy. 46 recipients died (33 died with functioning graft).
Between May 1992 through October 1998, twenty-two patients who had adolescent idiopathic scoliosis were treated using Universiti Kebangsaan Malaysia (UKM) spinal instrumentation and fusion. The minimum length of follow-up was 2 years with an average of 2.9 years. Nineteen patients were female and three patients were male. The mean age at the time of the operation was 16.2 years (range, 13 to 24 years). The average blood loss was 1,878 ml and the average operating time was 291 minutes. The mean pre-operative curve was 61.2 degrees, with a range of 40 degrees to 90 degrees. The average post-operative correction of the Cobb's angle was 53.5 per cent, with a range of 33 per cent to 81 per cent. Post-operative immobilization consisted of a maximum of six months in a body cast. There were no neurological injuries, no deep wound infections, and no evidence of pseudoarthroses. Only three complications occurred and these did not disturb the progress of the fusion. This technique safely achieves the objectives of scoliosis correction, and is cost-effective in the treatment of adolescent idiopathic scoliosis.
A clinical audit was conducted for a 4-year period at the Universiti Kebangsaan Malaysia (UKM) Ophthalmology Department in which 61 eyes of adult patients with primary glaucoma underwent trabeculectomies without antimetabolites. At a 2-year follow-up duration, successful trabeculectomies as defined by intraocular pressure below 20 mm Hg without additional glaucoma medication were 62% for primary open-angle glaucoma, 48% for primary acute angle-closure glaucoma and 43% for chronic angle-closure glaucoma. 50.8% of eyes were without complications while 49.2% had complications. Shallow anterior chamber (22.9%) and hyphaema (19.7%) were the two commonest complications.
Retrograde ureteroscopy, using the 12.5 French Storsz Perez-Castro Ellendt operating ureteroscope provides excellent visual access to the whole of the ureteric lumen in most instances. A total of 41 ureteroscopies were performed on a similar number of patients over a period of 12 months since April 1986. Majority of them were for ureteric calculi. Success rate for patients with ureteric calculi below the pelvic brim was 77.4%. A lower success was noted for calculi above the pelvic brim (50%). Retrograde ureteroscopy will eventually make blind basketing of lower ureteric stones an unnecessarily risky procedure and perhaps even obsolete. Ureterolithotomy nevertheless will still have a place in the management of stones that cannot be extracted either due to acute bullous oedema of the ureteric mucosa or in previously explored rigid non-yielding ureters not suitable for ureteroscopy.
This study analyses retrospectively the results of sixteen acute dislocations of the knee at the University Hospital, Kuala Lumpur from 1980 to 1985. The average follow-up was 3.5 years. There were seven posterior, six anterior, one lateral and two postero-lateral dislocations. All were due to motor vehicle accidents except one. There were four patients with popliteal artery injury and two patients with peroneal nerve injury; three required amputations due to late detection. All the peroneal nerve palsies were permanent. The results of surgical treatment appear to be better than conservative management of acute dislocation of the knee.
Fifty-one consecutive arthroscopies of the knee were reviewed after an average of eight months follow-up. Thirty-eight patients underwent arthroscopic surgical procedures as well. A meniscus tear was the commonest (68%) primary pathology noted, followed by isolated anterior eructate tears (16%). Excellent/good results were obtained in 80% of arthroscopic partial meniscectomies. Synovial biopsies and loose body removal were all successfully achieved arthroscopically: Arthroscopic knee surgery is a useful and less traumatic technique of obtaining a diagnosis and treating amenable knee lesions compared to open arthrotomy.
Objective: To review the presentation and outcome of developmental dysplasia of the hip (DDH) cases in the last 6 years. Methodology:We retrospectively reviewed the presentation as well as short and mid-term outcome of 17children (18 hips) with DDH seen and treated from 2004 to 2010. Treatment was either splinting with Pavlik harness,closed or open reduction depending on age at presentation and the individual needs of each patient. Results:Theaverage age at presentation was 31.1 months, and the male to female ratio was 1:4.6. Six patients (35%) presented early(less than 6 months old) while 7 patients (41%) presented between 6 -24 months. In these 2 groups splinting or closed reduction under anaesthesia was initially utilized for treatment depending on age, and open reduction was use dafter failure of closed reduction and for those presented late.Average age at the time of closed reduction was 11 months,and 6 years for those underwent open reduction. The average period of follow up for all patients was 29.4 months. The final outcome was successful in 12 hips (66%) in 11 patients.Ten of these presented at less than 2 years old, in the other 6 hips in which there was failure, 50% presented after 3 years of age. Conclusion:Late presentation of DDH is still common in Malaysia, which necessitates more complex management and more frequent occurrences of unfavourable results.