Review of risk factors associated with the anastomosis leakage in anterior resection in Hospital Universiti Kebangsaan Malaysia

This is a retrospective study evaluating the risk factors for clinical anastomotic leakage after anterior resection in 64 patients with rectal cancer operated from November 2001 till August 2003. The percentage of anastomosis leakage was higher in those patients with diabetic, low albumin level, neoadjuvant radiotherapy, higher staging, and poorly differentiated tumour. However, these differences were statistically not significant. There was a significant difference (p=0.03) of anastomosis leakage in those patients with very distal tumour of < 4cm from anal verge (42%), when compare to those patients with proximal tumor of > 15cm from anal verge (4.3%). The mortality associated with this complication was 30%. Hence, a surgeon may consider a covering stoma or be more vigilant in operating patients with multiple risk factors.

Colonies in engineered articular cartilage express superior differentiation

In view of poor regeneration potential of the articular cartilage, in-vitro engineering of cartilage tissue offers a promising option for progressive joint disease. This study aims to develop a biologically engineered articular cartilage for autologous transplantation. The initial work involved determination of chondrocyte yield and viability, and morphological analysis. Cartilage was harvested from the knee, hip and shoulder joints of adult New Zealand white rabbits and chondrocytes were isolated by enzymatic digestion of the extra-cellular matrix before serial cultivation in DMEM/Ham's F12 media as monolayer cultures. No differences were noted in cell yield. Although chondrocytes viability was optimal (>93%) following harvest from native cartilage, their viability tended to be lowered on passaging. Chondrocytes aggregated in isogenous colonies comprising ovoid cells with intimate intracellular contacts and readily exhibited Safranin-O positive matrix; features typically associated with articular cartilage in-vivo. However, chondrocytes also existed concurrently in scattered bipolar/multipolar forms lacking Safranin-O expression. Therefore, early data demonstrated successful serial culture of adult chondrocytes with differentiated morphology seen in established chondrocyte colonies synthesizing matrix proteoglycans.

The incidence of deep venous thrombosis following arthroscopic knee surgery

A prospective cohort study was undertaken at two centers to look for the incidence of deep vein thrombosis (DVT) following knee arthroscopic surgery. Eighty-four patients who had 90 arthroscopic procedures were reviewed. The relevant risk factors: past or family history of DVT, smoking, oral contraceptives, body weight, haemoglobin level, platelet count, tourniquet time and type of anaesthesia were documented. All patients were subjected to preoperative and post-operative duplex ultrasound. Only one patient (1.2 %) was noted to have DVT involving the peroneal vein. We concluded that the incidence of DVT after knee arthroscopy was very low in this study population.

Surveillance of acute flaccid paralysis in Hong Kong: 1997 to 2002

OBJECTIVES

To describe the characteristics of patients reported with acute flaccid paralysis between 1997 and 2002, and to evaluate the performance of the acute flaccid paralysis surveillance system using indicators recommended by the World Health Organization.

DESIGN

Retrospective study.

SETTING

Department of Health, Hong Kong.

PARTICIPANTS

Children aged younger than 15 years who were reported to the Department of Health between 1997 and 2002 with acute flaccid paralysis.

RESULTS

Of 120 children with acute flaccid paralysis reported between 1997 and 2002, 42% were younger than 5 years of age. None of the cases were acute poliomyelitis or polio-compatible. A neurological cause was identified in 67.5% of cases, of which the most common was Guillain-Barre syndrome (42%), followed by transverse myelitis (15%). All except one of the performance indicators consistently met World Health Organization requirements and thus demonstrated the effectiveness of the acute flaccid paralysis surveillance programme. The acute flaccid paralysis notification rate consistently exceeded 1.0 per 100 000 population below 15 years of age. The requirement for adequate stool investigation was the single indicator that did not satisfy World Health Organization requirements. This highlighted the importance of maintaining physicians' awareness of acute flaccid paralysis surveillance.

CONCLUSION

Hong Kong should remain vigilant for acute flaccid paralysis. The effective surveillance system and its evaluation may serve as a model for surveillance of other infectious diseases.

A server-mediated peer-to-peer system

A peer-to-peer (P2P) system is a popular means of file distribution. Existing P2P systems do not adequately address a variety of common problems including (1) limited search scope, (2) dynamic nature of peers and (3) lack of collaboration among peers. In this paper, we propose a server-mediated peer-to-peer system to address these problems and to improve the performance of existing decentralized P2P systems by incorporating a central server into the decentralized P2P system to facilitate collaboration among peers. Two main features of our proposed system are Assisted-search and Assisted-download. Experimental results show that the search coverage was increased by 289.91% by using Assisted-search, while the overall download speed was improved by 33% by using Assisted-download.

Case report of a difficult venous access: retroperitoneal approach of inserting an improved non-heparinised port for long-term use

This is a case report of a patient with difficult venous access following thrombosis of major superficial and deep veins of the limbs as documented by ultrasound doppler and venography. The insertion of a few central ports were infected and the vein thrombosed. Venography revealed that central venous access was no longer feasible. The previous laparotomies had resulted in dense intra-peritoneal adhesions, and rendered further laparotomy virtually impossible. The patient had occasional adhesion colics, vomiting and hypoglycemic episodes. A rarely performed retro-peritoneal approach of inserting an improved non-heparinised port proved to be effective for long-term management of this patient. The surgical approach and the selected port are discussed.

A review of day care ureteroscopy of a teaching hospital in Malaysia

This is a retrospective review of 200 day-care ureteroscopies performed between April 1998 and October 2002. The aim was to determine the feasibility and safety of this procedure. The mean age was 38.8 years and 75% of them were male. Eighty-three percent were ASA 1 and the remainders were ASA 2. The side of procedure were 48.5% right, 2.5% left and 6% both sides. Fentanyl and proprofol were used during induction. Calculi were found in 82.5% of cases. Rigid and flexible scope were used in 91.5% and 10.5% of cases. There were 33% upper, 23% mid and 44% distal ureteric stones. The mean stone size was 9.37 X 6.93mm. Seventy-four percent required a ureteric stent insertion. The mean operative time was 58.3 minutes. Four percent of patients experienced pain post-operatively relieved by NSAID injection. Repeat ureteroscopy performed in 30% of patients. There were zero admission rates. This study suggests day-care ureteroscopy is effective, safe and well tolerated by patients.

Tarsal tunnel syndrome caused by ganglion

We report a case of delayed diagnosis of tarsal tunnel syndrome caused by a ganglion arising from the talo-calcaneal joint. Unusually the symptoms were mainly due to the lateral planter nerve compression with a positive Tinel's sign. A surgical decompression was successful in relieving the dysaesthesia in spite of a 7 years history.

Skin-sparing mastectomy

Skin-sparing mastectomy is still in its infancy in Malaysia. The option of skin-sparing mastectomy is rarely given to patients as many general surgeons perform the conventional mastectomy. This could also be compounded by the lack of awareness amongst the local surgeons on the safety, surgical technique and treatment outcome of this relatively new procedure. This case report demonstrates the feasibility of this procedure performed on a Malaysian patient with a comparable outcome of those reported in the Western countries.

Anomalous diffusivity and electric conductivity for low concentration electrolytes in nanopores

We apply equilibrium and nonequilibrium molecular dynamics simulations to study the dynamic properties of electrolytes in nanopores. The realistic primitive model and the restrictive primitive model widely used in the statistical mechanics of liquid-state theory are applied to model the electrolytes. The electrolytic ions are immersed in water, treated in this work as either a dielectric continuum ignoring the size of solvent molecules or a macroscopic dielectric continuum (polar property) plus neutral soft spheres, and the aqueous electrolyte is put in a confined space. To simulate a condition mimicking closely processes of practical interest and yet maintaining the simulation computationally manageable, we consider an infinitely long and uncharged cylindrical tube. The equilibrium property of the self-diffusion coefficient D and the nonequilibrium property of electric conductivity sigma are computed in terms of electrolyte concentration, particle size, and cylindrical pore radius. The simulation results for the continuum solvent restrictive primitive model and continuum solvent primitive model show normal behavior for D versus pore radius R at ionic concentration 0.1M -i.e., D decreases with decreasing R -display an R independence of D at a certain threshold concentration and undergo an anomalous increase in D with reducing R at a lower value 0.025 M. The mechanism of the anomaly at the ionic concentration 0.025 M was sought for and interpreted in this work to arise from the energetic and entropic factors. Our simulated data of sigma at this same concentration follow the same trend as D. To delve further into the transport properties, we perform simulation studies for the discrete solvent primitive model and make a detailed analysis of the characteristic of the ion radial density functions. Comparison of the latter functions with those in the continuum solvent primitive model sheds light on the simulated diffusion coefficient within the context of discrete solvent primitive model which is about two orders of magnitude less. This difference in D is naturally attributed to the solvent effect. Similar disparities were reported by others for the discrete and continuum restrictive primitive models.

Spontaneous closure of a persistent post-traumatic pancreatic fistula in a child: incidental therapeutic effect of ERCP

A child with a post-tramatic pancreatic pseuodocyst developed pancreatic fistula, following percutaneous drainage of the cyst. The fistula output was about 120ml/day and lasted for a month. A diagnostic ERCP revealed main pancreatic duct disruption. The fistula output ceased over the next two days following the ERCP. The patient has been well for the past four years. This patient's immediate recovery after ERCP could possibly be due to dislodgement of a mucus plug by the contrast injected during ERCP. Such a mechanism can explain the previous sporadic reports of spontaneous cure of persistent pancreatic fistulae in children.

Outpatient treatment of spontaneous pneumothorax using an improved pocket sized Heimlich valve

We report two patients, who have used Pneumostat to replace the conventional underwater seal drainage system for recurrent pneumothorax. Both patients had required repeated chest tube insertion for recurrent pneumothorax and needed a longer hospital stay. Both patients were able to be discharged with the Pneumostat device and were reviewed in outpatient clinic. Both patients had optimal clinical improvement and chest X-ray showed no residual pneumothorax.

Benign childhood epilepsy with centrotemporal spikes: a study of 50 Chinese children

In order to collect local data for children with Benign Childhood Epilepsy with Centrotemporal Spikes (BECTS), we conducted a retrospective study of 50 Chinese children (32 males and 18 females) with BECTS diagnosed in two regional hospitals in Hong Kong from 1995 to 1998. Their peak age of onset was 7 years (range 3-13 years) and a male predominance was observed. Seven patients (14%) had a past history of febrile convulsions and five cases (10%) had a family history of epilepsy. The presentation was protean, but most of them had infrequent, short, nocturnal generalised seizures. The EEG spike foci were most frequently found in mid-temporal regions, followed by centrotemporal regions. Fourteen percent of children did not require anti-epileptic drug treatment. For those who were treated, they were easily controlled on a low dose of carbamazepine (median dosage of 12.75 mg/kg per day) or sodium valproate (median dosage of 20 mg/kg per day). Our study suggested a generally good prognosis for BECTS. No risk factors of frequent seizure recurrence could be identified.

Surgical management of large rotator cuff tears combined with instability in elite rugby football players

Large rotator cuff tears are extremely uncommon in young people and when they occur they may be associated with shoulder instability. This paper reports on a series of six elite rugby union and rugby league footballers who presented with shoulder instability and large rotator cuff tears. They were treated with a two stage procedure: an open rotator cuff repair followed by an open shoulder stabilisation some 10 weeks later. All had successful outcomes. The paper also highlights the risk of tearing the rotator cuff when a patient continues to play contact sport with an untreated unstable shoulder.

Juvenile-onset glycogen storage disease type II with novel mutations in acid alpha-glucosidase gene

The authors describe two novel mutations of the acid alpha-glucosidase gene, P361L and R437C, which define the juvenile-onset glycogen storage disease type II (GSDII) in a 16-year-old Chinese patient. The asymptomatic 13-year-old brother of the proband is also a compound heterozygote of the two mutations. These results confirm that intrafamilial phenotypic variation of juvenile-onset GSDII is ethnically diverse and suggest the contribution of other genes to the phenotypic variability of GSDII.

Lime improves emergence of canola on an acidic, hardsetting soil

Much of the agricultural lime applied in southern New South Wales, Australia, is applied to crops of canola (Brassica napus L.), but little is documented on the response of canola to lime. The few documented responses in grain yield of canola to lime application have been ascribed to decreased toxicities of aluminium and manganese. However, there is evidence that lime can have a structural effect on soil. A field experiment was limed in 1982 (0–5 t/ha) and was relimed in 1996 (0–5 t/ha) to give factorial combinations of 5 rates of 'old' (1982) and 6 rates of 'new' (1996) lime. When sown to canola in 1999 there was an increase in density of canola (from 17�to�60�plants/m2) and grain yield (from 1200 to 2700 kg/ha) associated with increasing rates of lime application. The emergence of canola was increased by 15% for each 1 unit increase in soil pHCa. Two subsequent pot experiments, conducted on cores taken from a subset of field plots with different liming histories, showed that lime application increased emergence of canola by about 9% for each 1 unit increase in soil pHCa. In addition, 2 contrasting watering treatments (gentle spraying and rapid flooding) were applied to the pots to either avoid or accentuate any soil structural breakdown. Flooding gave lower emergence compared with spraying (19 and 31%, respectively). Soil strength measurements (penetration resistance and shear strength) conducted on the surface soil (0–1 cm depth) during the second glasshouse experiment showed that lime application and gentle watering (spraying rather than flooding) resulted in lower soil strength. The soil strength measurements were related to emergence of canola. It is proposed that soil structural stability was the major contributor to these observed emergence differences. This is the first evidence in New South Wales of lime affecting plant performance via its influence on soil structure.

Sequestration of carbon and changes in soil quality under conservation tillage on light-textured soils in Australia: a review

Light-textured soils (<35% clay) make up more than 80%, by area, of cropping soils in Australia. Many have inherent soil physical problems, e.g. hardsetting, sodicity and low organic carbon levels. Maintenance and improvement of soil organic carbon levels are crucial to preserving the soil structure and physical fertility of these soils.A review of field trials on conservation tillage (3–19 years duration) on these soils in southern Australia revealed that significantly higher soil organic carbon levels compared with conventional tillage were found only in the wetter areas (>500 mm) and the differences were restricted to the top 2.5–10.0 cm. The average magnitude of the difference was lower than that reported in the USA. The lack of a positive response to conservation tillage is probably a reflection of a number of factors, namely low crop yield (due to low rainfall), partial removal of stubble by grazing and the high decomposition rate (due to the high temperature). There is evidence suggesting that under continuous cropping in the drier areas, the soil organic carbon level continues to decline, even under conservation tillage.Better soil structure and soil physical properties, namely macro-porosity, aggregate stability and higher infiltration have been reported under conservation tillage when compared with conventional tillage. However, little information on long-term changes of these properties under conservation tillage is available. As many of these soil qualities are associated directly or indirectly with soil organic carbon levels, the lack of significant increase in the latter suggests that many of these improvements may not be sustainable in the longer term, particularly in the drier areas. Continuous monitoring of long-term changes in the soil organic carbon and soil quality under conservation tillage in different agro-ecological zones is needed.

A review of burns patients admitted to the Burns Unit of Hospital Universiti Kebangsaan Malaysia

This is a retrospective review of 110 patients admitted to the Burns Units between October 1999 and November 2001. The aim was to determine the burns pattern of patients admitted to hospital UKM. There was an increasing trend for patients admitted. Female to male ratio was 1:2. Children consisted 34% of the total admission. Children had significant higher number of scald burns as compare to adult (p < 0.01). Domestic burns were consist of 75% overall admission. Mean percentage of TBSA (total body surface area) burns was 19%. Thirty percent of patients sustained more than 20% of TBSA. Sixty percent of patients had scald burns. Ninety percents of patients with second degree burns that were treated with biologic membrane dressing or split skin graft. Mean duration of hospital stay was 10 days. Over 70% of patients were discharged within 15 days. Overall mortality rate was 6.3%. The patients who died had significantly larger area of burns of more than 20% TBSA (p < 0.05) and a higher incidence of inhalation injury (p < 0.02). Hence, this study suggests a need for better preventive measures by the authority to prevent burns related accident and the expansion of the service provided by the Burns Unit.

Infantile isolated sulphite oxidase deficiency in a Chinese family: a rare neurodegenerative disorder

We report the clinical, biochemical, neuroradiological, and neurophysiological findings of a 4-year-old Chinese girl with infantile isolated sulphite oxidase deficiency. This is the first reported case in our locality. She presented at the age of 5 months with refractory seizures and developmental regression, and progressed rapidly to profound psychomotor retardation, spasticity, dystonia, microcephaly, and blindness. At the age of 3.5 years, she was admitted to the intensive care unit with septic shock. Ophthalmologic examination at this time revealed bilateral dislocation of the lens. Diagnosis of this very rare disorder was made on the basis of increased levels of urinary sulphite, thiosulphate, and sulphocysteine; normal urine xanthine and hypoxanthine; normal plasma uric acid; and low plasma cystine levels. The diagnosis was confirmed by the absence of sulphite oxidase activities in skin fibroblasts. Isolated sulphite oxidase deficiency is a rare inborn error of sulphur metabolism that is difficult to diagnose on clinical features and routine metabolic tests. The presence of ectopia lentis, seizures, and progressive neurological abnormalities should alert clinicians to the diagnosis.

Fetal programming of appetite and obesity

Obesity and related metabolic disorders are prevalent health issues in modern society and are commonly attributed to lifestyle and dietary factors. However, the mechanisms by which environmental factors modulate the physiological systems that control weight regulation and the aetiology of metabolic disorders, which manifest in adult life, may have their roots before birth. The 'fetal origins' or 'fetal programming' paradigm is based on the observation that environmental changes can reset the developmental path during intrauterine development leading to obesity and cardiovascular and metabolic disorders later in life. The pathogenesis is not based on genetic defects but on altered genetic expression as a consequence of an adaptation to environmental changes during fetal development. While many endocrine systems can be affected by fetal programming recent experimental studies suggest that leptin and insulin resistance are critical endocrine defects in the pathogenesis of programming-induced obesity and metabolic disorders. However, it remains to be determined whether postnatal obesity is a consequence of programming of appetite regulation and whether hyperphagia is the main underlying cause of the increased adiposity and the development of metabolic disorders.

Outcome of meniscus surgery at University Malaya Medical Centre

Between January 1994 to December 1998, 133 patients had a meniscal surgery at University Malaya Medical Centre. Fifty-four patients were assessed and scored with the Lysholm and Tegner scoring system. Twenty-nine patients had partial meniscectomies and 25 had meniscus repair. The outcome was successful in 80% with meniscal repair and 51.7% with partial meniscectomy. The outcome of meniscal repair in this study is comparable to other reported series. However, the failure rate for partial meniscectomy was high.

Fitting Item Response Theory Models to Two Personality Inventories: Issues and Insights

The present study compared the fit of several IRT models to two personality assessment instruments. Data from 13,059 individuals responding to the US-English version of the Fifth Edition of the Sixteen Personality Factor Questionnaire (16PF) and 1,770 individuals responding to Goldberg's 50 item Big Five Personality measure were analyzed. Various issues pertaining to the fit of the IRT models to personality data were considered. We examined two of the most popular parametric models designed for dichotomously scored items (i.e., the two- and three-parameter logistic models) and a parametric model for polytomous items (Samejima's graded response model). Also examined were Levine's nonparametric maximum likelihood formula scoring models for dichotomous and polytomous data, which were previously found to provide good fits to several cognitive ability tests (Drasgow, Levine, Tsien, Williams, & Mead, 1995). The two- and three-parameter logistic models fit some scales reasonably well but not others; the graded response model generally did not fit well. The nonparametric formula scoring models provided the best fit of the models considered. Several implications of these findings for personality measurement and personnel selection were described.

Analysis of P wave and P dispersion in children with secundum atrial septal defect

BACKGROUND

P maximum and P dispersion are evaluated as predictors of paroxysmal atrial fibrillation in adults. In this study, these variables are being investigated in children with secundum ASD in comparison with that of normal controls and in relation to size of ASD and the presence or absence of atrial dilation.

METHODS

Ninety-four children with isolated secundum ASD (33 boys, 60 girls; mean +/- SD age at diagnosis 2.9 +/- 4.1 years) and 65 age-matched controls (mean +/- SD age 4.2 +/- 4.2 years) were evaluated. Resting 12-lead ECG was used to measure P waves from which P maximum and P dispersion (difference between maximum and minimum P-wave duration) were derived. ASD children were arbitrarily subgrouped according to ASD sizes (small: 1-3 mm, moderate: 4-7 mm, large: > or = 8 mm). The presence of right atrial dilation was noted from echocardiography.

RESULTS

Children with ASD had significantly longer mean P dispersion compared to controls (P dispersion: 30.2 +/- 11.1 vs 26.4 +/- 6.6 ms, P = 0.008). Mean P maximum and P dispersion were significantly prolonged with increasing ASD size (P < 0.001). Children with right atrial dilation had significantly longer P maximum (102.3 +/- 15.2 vs 82.8 +/- 13.4 ms, P < 0.001) and larger P dispersion (36.1 +/- 12.5 vs 27.6 +/- 9.4 ms, P = 0.003) compared to those without right atrial dilation.

CONCLUSION

Prolonged atrial conduction time and inhomogeneity of atrial conduction may possibly be present in children with moderate to large sized ASD and in those with atrial dilation.

Effects of the testing situation on item responding: cause for concern

The effects of faking on personality test scores have been studied previously by comparing (a) experimental groups instructed to fake or answer honestly, (b) subgroups created from a single sample of applicants or nonapplicants by using impression management scores, and (c) job applicants and nonapplicants. In this investigation, the latter 2 methods were used to study the effects of faking on the functioning of the items and scales of the Sixteen Personality Factor Questionnaire. A variety of item response theory methods were used to detect differential item/test functioning, interpreted as evidence of faking. The presence of differential item/test functioning across testing situations suggests that faking adversely affects the construct validity of personality scales and that it is problematic to study faking by comparing groups defined by impression management scores.