Pattern of Urethritis in Males in a Kuala Lumpur STD (Sexually Transmitted Diseases) Clinic
Lim V K E, MSc, Bakar R A, MRCP, Department of Microbiology and Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, P.O. Box 2418, Kuala Lumpur

Summary
One hundred and thirty-eight male patients presented with a total of 146 episodes of urethritis at a Kuala Lumpur STD clinic over a period of six months. Gonorrhoea accounted for almost 4 out of 5 cases of male urethritis. The incidence of beta-lactamase producing strains of Neisseria gonorrhoea was 36 percent. Furthermore, nearly 3 out of 10 cases of gonococcal urethritis developed post-gonococcal urethritis.

Single-Dose Oral Ampicillin in the Treatment of Gonococcal Urethritis in Males
Ridzwan Bakar, MRCP*, V K E Lim, MSc**, *Department of Medicine, Department of Microbiology, Universiti Kebangsaan Malaysia, Jalan Raja Muda, Kuala Lumpur

Summary
One hundred and eight consecutive previously-untreated males with gonococcal urethritis were treated with single-dose oral ampicillin under supervision. A high failure-rate of 41.5 percent was obtained. The main cause of failure was the high incidence of penicillinase-producing Neisseria gonorrhoea - an overall incidence of 37.2 percent was obtained.

Infective Endocarditis of the Aortic Valve - Demonstration of Valvular Vegetations by M-Mode and Cross-Sectional Echocardiography
W H Ng, MRCP, Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Penang

Summary
The ability to visualise valvular vegetations by echocardiography is a significant advantage in the management of patients with infective endocarditis. In this report the M-Mode and Cross-Sectional echocardiographic appearances of infective endocarditis affecting the aortic valve are described. The uses and limitations of echocardiography are discussed.

A Preliminary Report on the Relationship between Serum Anti-Thrombin III Concentration in Pre- and Post-Operative Patients and in Women on Oral Contraceptives
Ton S H, PhD*, Lopez C G, FRCPA**, Thiruselvam A, BSc**, Lyou Y T, FRCS***, *Department of Biochemistry, ***Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, **National Blood Services Centre, General Hospital, Kuala Lumpur

Summary
AT III values in patients undergoing surgery were found to be lower post-operatively but the fall in value was not significant while women on oral contraceptives were found to have similar AT III values as that of women not on oral contraceptives. The observed values are discussed.

Suggestion of an Active Transport of Iron to the Fetus in Human Pregnancy and its Dependence on Maternal Serum Iron Levels
Jaffar Ali, MSc*, Khalid Hassan, DTM & H*, Hamid Arshat, MRCOG**, *Division of Haematology, Institute for Medical Research, Jalan Pahang, Kuala Lumpur, **Specialist and Reproductive Research Centre, National Family Planning Board, 2254, Jalan Temerloh, Kuala Lumpur

Summary
The present findings suggest the possible involvement of an active mechanism for transport of iron to the fetus. In all the 19 subjects studied, the cord serum iron levels tended to be higher (129.2 ± 56.8 ug/100ml) than the maternal serum iron levels (74.0 ± 35.9 ug/100ml) at parturition even in maternal iron deficiency. The significant difference (P < 0.001) between cord serum iron levels and the maternal iron levels shows that an active transport mechanism working against a gradient in favour of the fetus exists. The availability of iron to the fetus appears to be dependent on maternal serum iron levels but not on maternal iron stores. This finding serves to stress the importance of iron supplements in pregnancy. A hypothetical model for iron transfer from maternal circulation to fetal circulation is described.

Blood Glucose Control and Diabetic Microangiopathy
Cheah Jin Seng, FRACP, The University Department of Medicine ( I ), Singapore General Hospital, Outram Road, Singapore 0316

Summary
There is overwhelming evidence that the microangiopathic complications (retinopathy, nephropathy and neuropathy) of diabetes can be minimised, prevented or improved by optimal blood glucose control. There is little evidence to show otherwise. This paper reviews evidences to demonstrate that poor diabetic control predisposes to diabetic microangiopathy. The only way to minimise diabetic microangiopathy is to avoid hyperglycaemia and achieve euglycaemia for most part of the day. In doing so the dangers of hypoglycaemia must be clearly recognized and avoided.

Oral Verrucous Carcinoma in Peninsular Malaysia
K Ramanathan, MAAOP*, Peace Indrani Chelvanayagam, BDS*, T Jeyam Ganesan, BDS**, *Department of Stomatology, Institute for Medical Research, Kuala Lumpur, **Dental Clinic, General Hospital, Johor Bahru

Summary
Verrucous carcinoma is a form of squamous cell carcinoma which was first described as a district clinical and pathological entity by Ackerman in 1948. This study is the first report of 44 cases in Malaysians. Verrucous Carcinoma (VC) formed 1.8 percent of all oral squamous cell carcinoma cases. There was a predominance of males (M : F = 1.4 : 1). The peak age incidence was between 51 - 70 years (66 percent). The buccal mucosa (43 percent), gingivae (20 percent) and commissures of lips (17 percent) were the commonest sites of involvement. The Chinese who do not chew the betel quid had the least frequency of VC. No case was reported in the Chinese female. The highest frequency of VC was in the Indians who often added tobacco to their betel quids. Although thirty three years have passed since Ackerman's first description of VC it still remains a mystery. Clinicians, pathologists and immunologists in Southeast Asia have the opportunity to study and contribute to a better understanding of VC which of all variants of oral carcinoma seems to have the best prognosis if diagnosed and surgically excised promptly.

Oral Lichen Planus - A Study of Fifty-Four Cases
Hashim b Yaacob, MIHE, Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Malaya

Summary
Fifty-four patients with oral lichen planus were studied over a three-year period. The important sites were the cheek mucosa, tongue and gingiva. The reticular pattern was the most common type. The professionals and the white collar workers formed the majority of the cases. Emotional disturbances was a predominant factor in this lesion. The rate of malignant change ranges from one to ten percent. Treatment included reassurance, good oral hygiene, avoidance of hot and spicy foods and topical corticosteroids.

Oral Submucous Fibrosis - An Alternative Hypothesis as to its Causes
K Ramanathan, Department of Stomatology, Institute for Medical Research, Kuala Lumpur

Summary
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 hypersensitivity 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.

Benign Migratory Glossitis - A Cause for Worry?
Hashim b Yaacob, MIHE, Department of Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Malaya

Summary
A child and two elderly females with benign migratory glossitis (BMG) are presented. The aetiology is unknown, but emotional stress, mechanical and chemical trauma are important in the production of pain in an initially asymptomatic BMG. Treatment consists of reassurance, avoidance of hot, spicy and highly-seasoned foods. Any underlying reactive depression must be treated.

Tubal Ectopic Pregnancy
N Sivalingam, MRCOG, Queen Elizabeth Hospital, Kota Kinabalu, Sabah

Summary
Forty patients with tubal ectopic pregnancies seen over an 18 month period are studied. Epidemiological parameters in the three major groups are compared. The diagnostic problems, signs and symptoms are discussed. Aetiological factors in this area are compared with changing trends in other centres. Pelvic inflammatory disease remains an important cause. The role of conservative approach in surgical treatment of ectopic pregnancy is discussed. The crude incidence rate of ectopic pregnancy in Johore Baru Hospital between January 1978 and June 1979is 1 : 358 deliveries.