A case of Aeromonas hydrophila infection complicating an open Rolando's fracture of the hand is reported. Only two cases, both complicating open tibial fractures have been reported in the literature previously.' ,2 The organism was resistant to the usual antimicrobial (ampicillin and cloxacillin) used in the management of open fractures at University Hospital, Kuala Lumpur. The severity of the infection is largely dependent on the resistance of the host, and could vary from a locally spreading necrotizing cellulitis without systemic signs to a frank septicaemia with serious consequences. Early diagnosis with adequate debridement of the wound and appropriate antimicrobial to which the organisms are sensitive, are essential for effective control.
This paper deals with our experience of two cases of retropharyngeal abscess due to foreign body. A briefaccount ofthe anatomy. pathology, complications and treatment ofthis condition is given
A case of perforation of the uterus by the Multiload CU250 Device is described. To date no perforation of the uterus by this device has been reported. The device was successfully removed under laparoscopic control.
A 37 year old female who presented with a history of foreign body ingestion ten months previously was found on examination to have a retropharyngeal swelling. An initial differential of foreign body granuloma or retropharyngeal tuberculous abscess was considered. The usefulness of the lateral neck radiograph in demonstrating retropharyngeal pathology and the supplementary role of the computed tomography scan in confirming and elucidating the identity of the radio-opacity is highlighted. This presentation is a timely reminder of the need for a simple inexpensive lateral neck radiograph in situations of doubt as to persisting foreign body impaction.
Cement is a common cause of dermatitis. Workers affected are usually those in cement factories and at building construction sites. Cement dermatitis among port-workers is not so commonly reported. This paper describes an outbreak of dermatitis among stevodores at a port handling cement. The cement was imported in bags, and because of breakage, there was much spillage. It was also hot and dusty inside the hatch of the ship, and some of the stevodores worked bare-bodied. Cases of dermatitis began to appear in January 1983 and reached a peak in April 1983, gradually subsiding over the next few months to August 1983. This coincided with the increased tonnage of cement handled at the port. A total of 33 stevodores were reported as having dermatitis over this period. Of the 15 cases examined, 13 had eczema, and in 19 the hands and wrists were affected. However, most of the cases had multiple site involvement, including the arms, legs and abdomen.
Samples of cement showed the presence of water-soluble chromium, varying from 9.9 to 17.8pg/g. As the stevodores were reluctant to go for skin patch-testing, only four were tested, but two did not return for the reading of the results. The other two were found to have a positive reaction to dichromates. The outbreak of dermatitis was probably due to several factors which are discussed.
Perinatal mortality rates have been gradually declining in all countries. The initial decline mainly resulted from improvements in the late foetal mortality rates. Later with improvements in neonatal care, early neonatal mortality rates also improved. The developed countries have consistently shown better results than the developing countries, an indication of the higher standard of living, general health as well as the delivery of health care in these countries. In the Singapore situation, a rapid improvement in perinatal mortality was initially observed due to improvements in the late foetal mortality, followed later by reduction in the early neonatal mortality due to upgrading of neonatal intensive care. The perinatal mortality rate is lowest in the Chinese compared to the Indians and Malays, most likely due to the dietary practices of the three ethnic groups in Singapore; while the Chinese encourage extra nutrition in the pregnant female, the Malays and Indians tend to practise dietary restriction during this period. The improved nutrition of the pregnant mother is a factor in improving the perinatal mortality.
Incidence, aetiology, morphology, histology and symptoms of natal or neonatal teeth are presented. The commonly used terminology natal and neonatal teeth is adopted in this article. A case of an 8-week old girl with natal tooth and sublingual ulceration of the tip of the tongue is described.
Sixteen goats either subjected to transport stress or without transport stress were treated with dexamethasone for 3 days prior to infection with P. haemolytica serotype A2 intranasally. The transport-stressed and dexamethasone-treated goats in the first group had various degrees of pulmonary lesions and the organism was re-isolated from the nasal cavity, lymph nodes and lungs. None of the goats treated with dexamethasone only were infected with P. haemolytica and had no lesions of pneumonic pasteurellosis. Treatment with dexamethasone alone failed to induce experimental infection by P. haemolytica except in combination with another stress factor.
Virus associated haemophagocytic syndrome (VAHS), a distinct clinico-pathologic entity, is characterised by systemic proliferation of non-neoplastic histotiocytes showing haemophagocytosis resulting in blood cytopaenia. It has been described in relation to several viruses earlier. Here we describe a young girl who developed this reactive process during the course of dengue haemorrhagic fever (DHF).
Viral infections are probably the most important cause of childhood morbidity and mortality in the world. In many developing countries in South East Asia and the Western Pacific, priority health problems include acute respiratory infections, acute diarrhoeas and arboviral infections. Where studies have been carried out, there is no significant difference in the aetiological agents involved or in the manifestation of clinical childhood disease. Surveillance of these diseases have improved with the introduction of rapid viral diagnosis. The better understanding of the immunopathogenesis of many diseases have also encouraged research in this area and will lead to the better control and management of these diseases. However, the search for antivirals has been disappointing but fortunately new vaccines are on the horizon and the prospect for bringing some of these diseases under control through vaccination are bright.
A case of pseudomyxoma peritonei is reported. Pathogenesis, clinical features and modes of treatment are discussed. This patient appears to have responded to laparotomy, paracentesis and instillation of cyclophosphamide intraperitoneally.
In a prospective study of 300 infants with acute gastroenteritis 150 infants had enteropathogens in the stools, 58 being due to rotavirus, 130 to adenovirus, 32 to Sahnonella, 18 Shigella and 29 E. coli. Hypernatraemic dehydration was present in 11% and acquired carbohydrate intolerance in 30% of the infants. Protracted diarrhoea was observed in 8% of infants and was commoner in the bacterial than viral group. The study shows that clinical features and simple blood tests cannot be used as reliable indices of predicting the aetiology of AGE. Despite the diverse aetiology of acute gastroenteritis, rehydration by the oral or intravenous route remained the mainstay of therapy.
Keywords: Kuala Lumpur, university hospital,
A 50-year-old male had an acute jejunogastric intussusception complicating a Bilroth 11 gastrectomy done 20 years previously for peptic ulcer. Preoperatively, the diagnosis was suspected from the plain abdominal radiograph which was subsequently confirmed by barium meal. The patient had an uneventful recovery following resection of the intussuscepted segment and an end-to-end anastomosis. Although rare, the condition is serious and should be recognised promptly and treated surgically. The diagnosis should always be considered in a patient who has had a previous gastrojejunostomy presented with a sudden onset of epigastric pain, bloody vomitus and epigastric mass.
A case of amoebiasis with colonic perforation and ruptured liver abscess is reported. It is rare for both these complications to occur in the same patient. The management is described and the literature reviewed
Submucous fibrosis (SMF) an important precancerous condition occurs almost exclusively in Indians but cases have been reported from several countries throughout the world. The causes of SMF are unknown and there is no known treatment for it. Chillies, tobacco use, vitamin deficiencies and betel quid chewing have been implicated. Ramanathan is of the view that SMF seems to be the Asian version of sideropenic dysphagia. He suggests that SMF appears to be an altered oral mucosa following a prolonged period of chronic deficiency of iron and/or vitamin B complex especially folic acid. This changed state of the oral mucosa subsequently appears to develop more easily a hypersensz"tivity to oral irritants such as spices especially chillies and to the betel quid. He provides biochemical data as well as quotes several studies to support his hypothesis.