Filariasis in Negri Sembilan - A Follow-Up Study
Winnie C Cheah, Cheong W H, Mahadevan S, Karen P F Lai, Sivanandam S, Institute for Medical Research, Kuala Lumpur

Summary
Two years after the initial filariasis blood survey in a Negri Sembilan rubber plantation made by the Filariasis Research Division, Institute for Medical Research, Kuala Lumpur, in May 1970, another team from the same Division carried out a re-survey in August 1972 to assess the epidemiology of filariasis in and around the same areas, i.e. Sua Betong Estate (shaded area). Hetrazan had been given to the positive patients in 1970. The estate management was divided and sited as :

Sungala Estate was a small estate nearby, under a separate management but was included because cases had been suspected there.

Entomological studies to incriminate the vectors were then outside the scope of that particular survey. The present study includes entomological and parasitological studies in both the estates of Sua Betong and Sungala.

At the time of this blood survey, a change from rubber planting to oil palm planting, had been initiated and was expected to be expediated.

The estimated population in the area was 2,533 at the time of survey with age groups ranging from 6 months to 72 years.

Moniliformis moniliformis Bremser (Moniliformis dubius, Mayer) and its Prevalence in Rattus spp. in Penang, Malaysia
Khairul Anuar A, School of Biological Sciences, Universiti Sains Malaysia, Penang

Summary
Moniliformis Moniliformis which was formerly included in the Nemathelminthes is now recognized as a separate phylum, which is placed in immediate sequence to the Cestoidea, to indicate that the Acanthocephala are more closely related to the tapeworms than to any other group in the Animal Kingdom.

Though Moniliformis moniliformis is cosmopolitan in its distribution, till now there is no publication pointing out its existence in Malaysia, though the parasite Acanthocephala has been reported in Malayan rats. There has been no attempts made to describe the various species.

In the present Paper, the author presents the first record of the parasite namely Moniliformis moniliformis in this country.

Purulent Meningitis in Childhood
Lee E L, Khoo B H, Puthucheary S D, Thong M L, Department of Paediatrics and Medical Microbiology, University of Malaya, Kuala Lumpur

Summary
This is a review of 59 cases of purulent meningitis in children between the age of 1 month and 12 years. The clinical features at presentation are often non-specific and diagnosis frequently masked by previous antibiotic administration. H. influenziae and Strep. pneumoniae are the two most common causative organisms. The overall mortality rate of 15% is similar to most published figures. However, only 50% of children escaped demonstrable brain damage. Currently, penicillin with chloramphenicol or ampicillin alone are recommended for initial therapy. If results are to be significantly improved, theh infection must be detected it its early stages by the liberal use of lumbar puncture while antibiotics are withheld. The goal in chemotherapy is to ensure an adequate concentration of the appropriate antibiotic in the CSF. In addition, treatment must be directed towards the prevention and prompt management of the metabolic derangement and other complications accompanying the disease.

Serodiagnosis of Parasitic Infection
Vijayamma Thomas, Department of Parasitology, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
Detection of the characteristic stages of parasites in the blood, tissues, stools, other excretions and secretions of the host is the proof of parasitic infections. Negative results, however, do not exclude the presence of parasites especially if they have been altered by drugs, or when they are present at sub-patent levels as often is the case in very light, early, or in late infections. At times, microscopic examination is impossible or impractical due to the location of the parasites in the deep tissues. Diagnostic techniques may be laborious and time-consuming. Tissue biopsy or aspirations for parasites may be traumatic and also may give negative results. Under such conditions, diagnosis is often made from the clinical history, symptoms and signs alone. The clinical picture of most parasitic infections is highly variable.

Serodiagnostic techniques have been found useful in supporting the clinical observation or to rule out these diseases. Although serological techniques have been used for diagnosis of parasitic infections from early years of this century, only in the last few years have these tests received general acceptance. At present, the interest in the serological diagnosis is fast increasing and such techniques are available for at least 24 parasitic infections.

Many reviews on the recent advances in the immunodiagnosis of parasitic infections are available (Miller and Brown, 1969; Kagan and Norman, 1970; Denham et al, 1971; Singh and Yap, 1971; Fife, 1971; 1972; Kagan, 1974; 1976a; 1976b and Sadun, 1976). A number of serodiagnostic techniques both quantitative and qualitative, are employed for serodiagnosis of parasitic infections. However, none of these is universally accepted as the best single method. Each method has its uses, advantages and limitations. A combination of several tests and antigens are recommended for more accurate results. This Paper discusses briefly the serodiagnostic techniques that are commonly used for parasitic diseases, their applications and limitations.

Treatment of Hypertension with Acebutolol
Ngeow Took Fah, Consultant Physician, District Hospital, Segamat, Johor

Summary
Of 28 patients included in a trial of oral Acebutolol for the treatment of hypertension, 23 were eligible for assessment. Acebutolol alone was successful in controlling the blood pressure in 17 patients (74%), mild and moderate cases showing the best response. Combination therapy with chlorothiazide did not improve the response rate apreciably. The five treatment failures had severe hypertension with mean arterial pressure exceeding 140 and had all been previously unresponsive to other anti-hypertensive agents.

Tolerance throughout the trial was good. The commonest side effect noted was weight gain which was unrelated to fluid retention. Giddiness, lethargy, drowsiness and increased sweating occurred occasionally and transiently. Two patients with chronic obstructive airway disease tolerated the drug without developing bronchospasm, thus confirming the cardioselective property of the drug. Cardiac decompensation occurred in two patients with cardiomegaly necessitating digoxin and diuretic therapy. Despite its intrinsic sympathomimetic activity, the drug should be used with caution in patients with impaired myocardial contractibility.

The Diagnosis and Current Treatment of Liver Abscess
M Vijendran, First Surgical Unit, General Hospital Kuala Lumpur

Summary
The seriousness of liver abscess cannot be over-emphasized. Liver inadequacy resulting from the space occupying lesion results in severe metabolic derangement, compounding the threat to life. Considering the evidence, the following outstanding observations were finally made :

1. The diagnosis of liver abscess is mainly a clinical finding.
   
2. Abscesses more than 5 cm in diameter if left undrained produced a 100% mortality. Cavities less than this size often healed spontaneously with supportive regimen alone.
   
3. Drainage from abscess is most effective is made dependent. Tube drains are essential and may be necessary to be kept in place for weeks.
   
4. Loculations within an abscess are made to communicate. Strands of connective tissue that span cavities are safeguarded; these are periportal connective tissue that acts as scaffolding for regenerating liver cells.
   
5. Liver regeneration can be estimated by serial sinograms done through tube drains and also by scanning. Liver regenerates from the periphery and takes more than ten weeks to be complete.
   
6. Open drainage has reduced mortality from 75% in the pre-antibiotic era to about 12.5% in this series. Even with limited facility, good results can be obtained.
   

Pathway for Pain - Some Anatomical and Clinical Considerations
Gurmit Singh, Lecturer and Acting Head, Department of Anatomy, Faculty of Medicine, University of Malaya

Summary
The clinical management of pain is a problem that continuously confronts the physician, but there are still wide gaps in our knowledge regarding the structure and physiology of pain receptors and the central pathways mediating this sensory modality. It is hoped that a sound knowledge of the anatomical pathway for pain, outlined earlier, will help the doctor understand some of the clinical phenomena produced when this pathway is interfered with by pathological processes, and also rationalize the many and varied methods available to produce relief of pain.

Acute Arterial Embolism
H S Saw, Department of Surgery, University Hospital, Kuala Lumpur

Summary
Acute peripheral arterial embolism is commonly encountered today. The significance of considering this entity as a medical and surgical emergency is stressed and its management outlined.

A Report on 102 Rubber-Band Ligations of Internal Hemorrhoids
Huang Kuo An, 16, Aston Road, Bukit Mertajam, Province Wellesley, Penang

Summary
The technique of rubber-band ligation of internal hemoorrhoids was described and a series of 102 ligations on 78 patients with internal piles was reported. It was concluded that the procedure was highly effective and acceptable to the patients and could be easily carried out in the office without fear of complications which were rare.

Windscreen Eye Injuries in Singapore
Low Cze Hong, Ang Beng Chong, Department of Ophthalmology, Singapore General Hospital

Summary
Twenty-three patients seen over a two and a half year period (1975-1977) had severe eye involvement following windscreen injuries. Seventeen (73.9%) were front seat passengers and 6 (26.1%) were drivers. The significant finding was that none wore seat belts. Twenty-four eyes were injured in 23 patients (one patient had both eyes injured). The extent of eye injury was severe; 16 (66.7%) eyes had moderately severe injury and 8 (33.3%) eyes had very severe injury including two blind eyes. The final visual outcome was poor in spite of surgery; over 2/3 had significant visual deficit. Twenty-one (91.2%) cases were economically active and were young patients whose age range from 15 to 39 years. If seat belts and possibly safety plastic lenses (for those who need spectacles) were used, we believe these injuries could be minimized if not prevented.

Torsion of the Tests : A Review of 24 Cases
Wong Twee Juat*, Ong Tat Hin**, Kylasa Somasundaram***,*Medical Officer, **Associate Professor, ***Professor and Head of Department, Department of Surgery, University Hospital, Kuala Lumpur

Summary
A review of 24 cases of torsion of the testis is presented. The clinical picture, main differential diagnosis and management are discussed. No new observations were made. Rather, previous observations were re-emphasized. Torsion of the testis is an operative emergency. Only with early diagnosis and prompt surgery can the affected side be saved.

Planning for an Airport Disaster
J Francis Silva, Department of Orthopaedic Surgery, University of Malaya, Kuala Lumpur

Summary
The increase in the numbers of passengers and commercial aircraft using an international airport will create major problems in the handling of accidents at airports and in their immediate vicinity. For this purpose, this Paper has outlined a scheme for daily emergencies at international airports. This organization would be the nucleus of medical activity in the event of a major air disaster. The organization for such a catastrophe and the back-up organization needs have been outlined as well as the organization needed for the case of casualties.

Rehabilitation - Its Role in Psychiatry
M Parameshvara Deva, Lecturer, Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur

Summary
The three aspects of psychiatric rehabilitation, i.e. psychological, social and occupational rehabilitation are inter-related in their common aim. The recovering mentally ill patient is hardly a patient who is well and rehabilitation forms an integral part of management in psychiatry. A wide variety of therapies are available for patients who need psychiatric rehabilitation.

Advances in the Surgical Treatment of Peptic Ulcer
T K Ti, Associate Professor, Department of Surgery, University of Malaya, Kuala Lumpur

Summary
A concluding remark on proximal gastric vagotomy might be relevant. As the present time, proximal gastric vagotomy should still somewhat be considered an experimental project and its use should be confined to university centres and those engaged in prospective randomised studies.