Cerebrotendinous xanthomatosis (CTX), a rare inherited lipid storage disease is due to a defect in bile acid metabolism. Involvement of five members of a family is presented. The clinical features, laboratory and pathologic findings are discussed. Tendinous and tuberous xanthomatosis, bilateral cataracts, cerebral impairment and raised serum cholestanol are the salient features. We believe this is the first report of CTX in Malaysia.
Ultrasound examinations were done to evaluate clinically palpable abdominal masses in 125 children. The examinations were normal in 21 patients. In 15 patients, the clinically palpable masses were actually anterior abdominal wall abscesses or hematomas. Final diagnosis was available in 87 of 89 patients with intraabdominal masses detected on ultrasound. The majority (71%) were retroperitoneal masses where two-thirds were of renal origin. Ultrasound diagnosis was correct in 68 patients (78%). All cases of hydronephrosis were correctly diagnosed based on characteristic ultrasound appearances. Correct diagnoses of all cases of adrenal hematoma, psoas abscess, liver hematoma, liver abscess and one case of liver metastases were achieved with correlation of relevant clinical information.
Sixty two patients with displaced femoral neck fractures treated by percutaneous pinning are reviewed. There were 37 females and 25 males with an average age of 63.7 years. There were 36 Garden grade III and 26 grade IV fractures. Twenty three patients had other medical conditions. Fourteen patients were operated under local anaesthesia. Superficial wound infection was found in three cases with no deep infection. Union occurred in 41 patients by eight months. Of the 21 non-unions 15 remained painless. The pins migrated outwards in seven cases but caused no clinical problem. Avascular necrosis was seen in 11 patients by 18 months. Avascular necrosis and non-union occurred together in six patients. Secondary hemiarthroplasty was performed in only ten patients. Routine hemiarthroplasty for femoral neck fractures is not always indicated. Femoral head preservation should be attempted before prosthetic replacement. The pinning surgery is simple, fast and can be performed under local anaesthesia. Hemiarthroplasty should be reserved for failed cases only.
The occurrence of post-operative wound infection was studied respectively over an eight month period in the University Hospital, Kuala Lumpur. One hundred and seventy four (3.4%) surgical wounds out of 5129 operations became infected. The clean wound infection rate was 2.9%, rising to 5.4% and 12.2% for clean-contaminated and contaminated surgical wounds respectively. Of the wound infections, 80.8% occurred within the first two weeks post-operatively. Bacteriological studies revealed that the commonest bacterial isolates were Staphylococcus aureus (36.1%), Pseudomonas aeruginosa (15.4%) and Klebsiella species (10.1%).
Thirty-six asymptomatic infertile women undergoing laparoscopic examination as part of their infertility investigations, were included in this study on chlamydial infection. Patients were tested for chlamydial antigen in the cervix and peritoneal fluid. The serum of twenty-five of these patients was titrated for evidence of chlamydial antibodies. Fifty women attending a family planning clinic were used as a control group. The study showed a strong relationship between chlamydial infection and infertility due to tubal pathology. The incidence of chlamydial infection in asymptomatic infertile women was 33.3%. The results indicate that Chlamydia trachomatis should be sought in patients presenting with infertility and, if detected, appropriate medical treatment be given.
A community based study was conducted on the understanding and knowledge of childhood diarrhoea and use of oral rehydration therapy (ORT), in four selected villages in Tumpat District, Kelantan. The calculated annual incidence of diarrhoeal disease in children aged 0 to four years in all study villages was 1.38 episodes for each child. The main care-givers of children aged 0 to four years were interviewed and asked to demonstrate how to mix a standard ORS (oral rehydration solution) sachet if they had previously used ORT. Forty percent of care-givers had heard of the locally available ORT and 30% had actually used ORT. Of those who had heard of or used ORT, 10% had good knowledge of what it was and what it was used for, 51% had some knowledge and 39% had either no knowledge or inaccurate knowledge. Of care-givers who had previously used ORT only 20.5% demonstrated the correct volume of water to add to one sachet of ORT, but 82% would discard an unused solution within 24 hours. Significantly more literate women had used ORT than those not literate (p = 0.002). Mothers, particularly those literate, are the primary target group for ORT intervention strategies. Components of health education should include advice on what ORS is, what it is used for, and how to correctly mix a standard sachet.
Health indices of 317 healthy elderly Malay females 55 years and older from two rural subdistricts in Negeri Sembilan were collected through personal interviews. About 33% of the respondents perceived their health condition as good to excellent, 63.4% rated their health status compared to a year earlier as about the same, 48.3% had no worry about their health, and 49.2% perceived themselves as physically active as their peers. Arthritis was the major ailment which affected the daily activities of about 64% of the respondents. The classical age-related problems of poor hearing, poor sight and difficulty in chewing were also prevalent among these elderly.
This study investigated whether knowledge and attitudes of Malay college students regarding smoking can be positively influenced by educational intervention. The experiment included a pretest to assess the students knowledge and attitudes regarding smoking, a lecture on the health risks associated with smoking, and a posttest given six weeks later to assess whether any changes had occurred. A profile of the typical Malay student smoker was also elicited. Twenty-seven percent of the study population were smokers. Of the men in the sample, 44% were smokers, while less than 4% of the women were smokers. T-tests indicated that knowledge of the health risks associated with smoking was significantly improved for most groups, while attitudes towards smoking were essentially unchanged.
Thirty one patients were investigated for the main complaint of easy bruising. These patients had normal platelet count with no past history of immune thrombocytopenia or systemic disorders known to predispose to bruising and a negative drug history. The evaluation of these patients included clinical review (history and physical examination) plus coagulation tests consisting of bleeding time, prothrombin time, partial thromboplastin time, thrombin time, fibrinogen level, FXIII screen and platelet functions test. Seven of the paediatric patients had acquired platelet dysfunction with eosinophilia (APDE). In 17 (94.4%) of the 18 adult patients no abnormality was demonstrated. Hence APDE was the commonest cause of easy bruising in children while the haemostatic defect contributing to easy bruising in adults remained unknown.
Two cases of tuberculosis of the thoracic spine with extrapleural extension of paravertebral abscesses, presenting radiologically as cold abscesses away from the spine in the PA chest radiograph, are presented. The radiographic features and response to antitubercular drugs are discussed.
Two cases of longstanding foreign bodies in the larynx and lower laryngo-pharynx were accurately localised by direct coronal3 and limited axial CT scans of the neck. The relationship of the foreign bodies with the surrounding structures and associated changes are demonstrated clearly.
A successful retrieval of a detached segment of a CVP catheter by percutaneous right transfemoral venous route, using a Dotter intravascular retriever basket, is reported. The procedure was monitored under fluoroscopy. Only local anaesthesia, which was infiltrated around the puncture site, was given to the patient. No significant complication was encountered. Successful retrieval of the detached catheter fragment by percutaneous means obviates the need for thoracotomy.
MeSH terms: Aged; Catheterization, Central Venous/adverse effects*; Catheterization, Central Venous/instrumentation; Foreign Bodies/radiography; Foreign Bodies/therapy*; Humans; Male
This report deals with a father and his son who developed acute renal failure following multiple bee stings. The renal lesion in these patients appears to be due to rhabdomyolysis caused by the bee venom. The other mechanisms are also discussed. The need for clinicians to be aware of acute renal failure as a complication of bee stings is stressed.
A 13 year old girl presented with miliary tuberculosis and active systemic lupus erythematosus (S.L.E.). She responded to a combination of antituberculous drugs and systemic steroids. This case illustrates the fact that S.L.E. presenting in childhood may be rare but not unknown and exemplifies the need for vigilance in detecting life threatening infections in this group of patients.
A case of tetanus occurring after induced abortion is reported. The patient gave a history of low grade fever with chill and rigors, headache, neck pain and Trismus. She subsequently developed respiratory distress. However, incorrect information from the patient resulted in the delay to locate and eradicate the source of infection. Early referral to an intensive care unit for ventilatory assistance was the most appropriate step to save the patient. Complications which occurred during the course of the disease were sometimes difficult to overcome. These complications were probably related to the duration of stay in the intensive care unit. Their incidence could be reduced by more meticulous patient care.
A rare case of gestational trophoblastic disease (GTD) in a 54-year old Malay woman is described. A total abdominal hysterectomy with bilateral salphingo-oopherectomy was done. She was given methotrexate therapy as she had persistent high levels of serum B hCG.
An association of idiopathic systemic lupus erythematosus (ISLE) with genetically determined N-acetylation polymorphism has been suspected from previous studies, mainly on Caucasian populations in which there is an approximate incidence of 50% of slow and rapid acetylators. The present study is of the incidence of ISLE and acetylator status in a mixed population of Malaysia. The results did not support an association between ISLE and acetylator status: the frequencies of slow acetylators in the ISLE patients who were Malaysian Chinese and Malay were 13 and 38% respectively. This did not differ significantly from the respective healthy groups (20 and 29%). The small number of Indians in the survey did not allow a valid comparison, but the figures did suggest a lack of association between ISLE and acetylator status.