Malaysian Journal of Medical Sciences School of Medical Sciences, Universiti Sains Malaysia ISSN: 1394-195X Vol. 11, Num. 2, 2004, pp. 74-88

Malaysian Journal of Medical Sciences, Vol. 11, No. 2, July 2004, pp. 74-88

ABSTRACT, 9TH NCMS, 22 - 23 MAY 2004, UNIVERSITI SAINS MALAYSIA, HEALTH CAMPUS, KUBANG KERIAN, KELANTAN - Oral Presentations A1-1 - A2 -3

Code Number: mj04024

ORAL (A1 -1)

M. Noor Zairul, N. M. Nik Abdullah, A. H. Azmi, M. Z. Rhendra Hardy, G. Ghazaime, O. Mahamarowi, J. Kamarudin,

Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia

Objective

To assess whether the newly developed laryngeal tube (LT) is comparable to laryngeal mask airway (LMA) in terms of easiness of insertion, haemodynamic response and complications in spontaneously ventilating adult patients undergoing general anaesthesia.

A randomized single blinded prospective study on 121 ASA I or II premedicated patients, aged 18 to 65 years. Patients were divided into 2 groups receiving either LT or LMA as for airway management during elective surgery. After induction of anaesthesia with fentanyl 1.5 ug.kg^-1 and propofol 2 mg.kg^-1, a size 3 or 4 LT or LMA was inserted and the patients breathed spontaneously throughout the surgery. Anaesthesia was maintained with nitrous oxide, oxygen and isoflurane. The airway device was removed at the end of surgery with the patients fully awake. The speed and ease of insertion and the number of attempts needed to successfully secure the airway were recorded. The incidence of airway trauma, sore throat, systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at different time intervals were recorded.

There was no significant difference in time required for successful insertion and number of attempts for both groups. A clear airway was achieved in 75.4% patients in LT group at the first attempt. There were no difference in incidence of airway trauma and sore throat between LT and LMA. Both groups had no statistical differences in blood pressure and heart rate changes.

During general anaesthesia with spontaneous ventilation, the LT is a suitable alternative to the LMA.

ORAL (A1 -2)

A COMPARATIVE STUDY BETWEEN INVASIVE BRONCHOSCOPY (BY USING BRONCHOALVEOLAR LAVAGE TECHNIQUE) AND NON-INVASIVE DEEP ENDOTRACHEAL ASPIRATION IN DIAGNOSING VENTILATOR –ASSOCIATED PNEUMONIA

W. A Rohaidah, O. Mahamarowi, G. Norhafidzah, J. Kamarudin, M. Z. Rhendra Hardy, N. M. Nik Abdullah

Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

Objectives

To compare the safety and efficiency of endotracheal aspiration and bronchoscopic bronchoalveolar lavage in diagnosing VAP (Ventilator Assocaited Pneumoniae).

Methodology

A prospective study on 100 patients with clinical diagnosis of VAP by new, progressive infiltration on CXR, fever, leucocytosis, purulent sputum and PaO2/FiO2 less than 240 were randomly assigned into one of the two groups. Group 1 (n = 50) underwent endotracheal aspiration and group 2 (n = 50) underwent bronchoscopic bronchoalveolar lavage. All specimens obtained were immediately sent to microbiology laboratory. All microorganisms isolated were identified by standard laboratory methods. Threshold of 10⁵- 10⁶ Colony Forming Unit/ml for endotracheal aspiration and 10⁴ Colony Forming Unit/ml without antibiotic, 10³ Colony Forming Unit/ml with antibiotic for bronchoalveolar lavage were taken for diagnosis of ventilator-associated pneumonia. Complications and qualitative bacteriologic culture were also recorded.

Results

VAP was confirmed in 36 (72.0 %) patients by using deep endotracheal aspiration technique as compared to 34 (68.0 %) patients by using the bronchoalveolar lavage technique (p=0.828). 31 (31.0 %) failed to grow any culture. Only 1 (2.0 %) out of 50 patients in the bronchoalveolar lavage group had SaO₂ less than 90%. No other complication occurred in that group. No complication was noted in the endotracheal aspirate group (p =1.0). Mortality occurred in 18 (36.0 %) patients in endotracheal aspirate group and 25 (50.0%) patients in bronchoalveolar lavage group.

Conclusions

The quantitative cultures of endotracheal aspirate were comparable to the bronchoscopic bronchoalveolar lavage technique. It is also but simpler, inexpensive and less invasive.

ORAL (A1 -3)

A COMPARISON OF HAEMODYNAMIC CHANGES AFTER ENDOTRACHEAL INTUBATION USING LIGHTWAND DEVICE (TRACHLIGHT) AND THE LARYNGOSCOPE.

T. Norizan, P. Gnandev, G. K. Sobha, J. Kamarudin, M. Z. Rhendra Hardy, O. Mahamarowi, N. M. Nik Abdullah

Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia

Lightwand intubation is a gentle intubating technique involving transillumination of the soft tissue of the neck. In comparison to direct laryngoscopy, it is expected to cause less haemodynamic changes after tracheal intubation and may prove beneficial to patients with coexisting diseases.

To compare haemodynamic changes and complications following tracheal intubation using lightwand versus direct laryngoscopic technique.

A single blinded randomized controlled study of 140 patients, who were given general anaesthesia for elective surgery. Subjects were randomly assigned to either LSI (endotracheal intubation by direct laryngoscope) or LWI group (endotracheal intubation by trachlight). A standardized anaesthetic technique was used and endotracheal intubation was performed after the anaesthetic induction and muscular paralysis. Noninvasive systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were recorded preinduction, preintubation, immediately after intubation and every minute for the first five minutes after intubation. Postoperatively, patients were assessed for hoarseness of voice, sore throat and dysphagia.

There was no significant difference in the haemodynamic parameters between the two techniques. The number of intubation attempts was similar but the intubation time was longer in LWI group (25.7 ± 14.8 vs. 20.0 ± 8.4). The incidence of hoarseness of voice was lower in LWI group (0.1 % vs. 7.6 %), p < 0.05. There was no difference in other pharyngolaryngeal morbidity between the two groups.

Trachlight intubation produced similar haemodynamic changes and less laryngeal trauma as compared to the direct laryngoscopic technique.

ORAL (A1 -4)

A COMPARATIVE STUDY OF INTRAVENOUS PATIENT- CONTROLLED ANALGESIA MORPHINE AND TRAMADOL IN PATIENTS UNDERGOING MAJOR OPERATION IN HUSM

M. R. A. Hadi, H. Shamsul Kamaruljan, K. Junaidi, A. Saedah, A. J. Nizar, G. Ghazaime, N. M. Nik Abdullah

Department of Anaesthesiology, School of Medical Sciences, University Sains Malaysia, Kelantan, Malaysia

Introduction

Morphine has been commonly accepted as opioid analgesia of choice in patient controlled analgesia (PCA) technique. Tramadol is a newer analgesic with lower side effects but its role in PCA has never been established.

To evaluate the effectiveness of intravenous PCA tramadol in comparison with PCA morphine in term of analgesic properties, sedation and the incidence of side effects.

A randomized, double-blinded study on 160 ASA I and II patients who were divided into two groups. Following surgery, the PCA morphine group (n=80) received a loading dose of 0.1 mg.kg^-1 of intravenous morphine followed by 1 mg (1 mg.ml^-1) of PCA infusion as required. The PCA tramadol group (n=80) received a loading dose of 2.5 mg.kg^-1 of intravenous tramadol followed by 10 mg (10 mg.ml^-1) of PCA infusion as required. The lockout intervals were 10 minutes and none of the patients received baseline infusion. Patients were monitored for pain score (Modified pain score), sedation levels (Ramsay sedation score), respiratory rate, nausea, vomiting, pruritus, blood pressure and pulse rate at 30 minutes, 4 hours, 24 hours and 48 hours post operation.

There were no significant different in the mean pain score and mean sedation level between the two groups at 30 minutes, 4 hours, 24 hours and 48 hours post operation (p 0.05). There were also no difference between the two groups in the incidence of nausea, vomiting and pruritus.

PCA tramadol is comparable and may be used as an alternative to PCA morphine for postoperative pain management.

ORAL (A1 -5)

M. S. Abu Bakar, A. J. Nizar, B. Baharuddin, H. Roslina, J. Kamarudin, H. Shamsulkamalrujan, N. M. Nik Abdullah

Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

To determine the effect of epidural analgesia on the progress of labour in the perspective of duration of labour and modes of delivery.

One hundred and ninety two (192) uncomplicated full term gravida 2 – 5 women with tested pelvis in spontaneous labour were randomized to receive either epidural ropivacaine 0.2 % with fentanyl 2 µg.ml^-1 or intramuscular pethidine analgesia. Epidural catheter was inserted at first request of pain relief during active phase of labour at cervical dilatation of 3 to 5 cm.

Epidural analgesia significantly provides good analgesia after 15 minutes (Mean Visual Analogue Score 15 minutes was 11.3 mm vs. 68.6 mm, P = 0.001) and at full dilatation (25.1 mm vs. 94.4 mm, P = 0.001). 86% of patients experienced no motor block in the epidural group. There were significant associations between epidural administration and prolongation of first stage (506.6 min vs 392.1 min; P = 0.001) and second stage (24.0 min. vs.10.1 min; P = 0.001) of labour. Instrumental delivery but not the caesarean section rates were increased. (11.7% vs. 2.1%, P = 0.008), (11.7% vs. 7.1%, P = 0.186) respectively. No difference in neonatal outcome as shown by Apgar score at 1 and 5 minutes. Patient satisfaction was statistically significant whereby 84% of patient opted for epidural analgesia for next delivery.

Epidural ropivacaine 0.2% with fentanyl 2 µg.ml^-1 provides better labour analgesia than intramuscular pethidine despite prolongation of labour and increased instrumentation. It was not associated with increased incidence of caesarean delivery when compared with intramuscular pethidine analgesia.

ORAL (A1 -6)

S. Ananda, N. M. Nik Abdullah, A. Muhammad Zihni, O. Mahamarowi, P. Gnandev, J. Kamarudin

Departmant of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia

The onset time of rocuronium is partly determined by the speed in which these drugs reach the neuromuscular junction, a factor that appears to be proportional to the cardiac output and muscle blood flow (Simhi and Brandon et al., 1998). Ephedrine is an indirect acting synthetic noncatecholamine that stimulate _ and _adrenergic receptors and it may promote increase blood flow to the neuro-muscular junction and therefore may fasten the onset of rocuronium.

To evaluate the effect of low dose ephedrine administration on the onset time of rocuronium.

A double-blinded prospective study on 44 ASA I and II patients (22 per group), aged between 18 – 60 years who underwent elective surgical procedures. Patients were randomly assigned to receive either i.v ephedrine 50 µg.kg^-1 (group 1, n=22) or i.v normal saline (group 2, n=22). Neuromuscular function was assessed by stimulation of the ulnar nerve with train of four monitoring with supramaximal square wave impulse of 0.2 seconds duration administered 2Hz every 10 sec. The onset of rocuronium was defined as the time in seconds from the end of injection of i.v rocuronium to the disappearance of all four twitches of the train of four in the nerve stimulator.

The onset time of rocuronium in the ephedrine group was significantly faster (70 + 17.5) than the onset time for saline group (99 + 18.3).

Administration of low dose intravenous ephedrine (50 µg.kg^-1) prior to rocuronium helps to fasten the onset time of rocuronium.

ORAL (A1 -7)

M. Nazri, A. Saedah, M. Azhar, H. Shamsul Kamalrujan, G. Ghazaime, J. Nizar, N. M. Nik Abdullah

Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia

To compare the intubating conditions and haemodynamic changes in adults following 2 methods of anaesthetic induction, using inhaled sevoflurane 8 % -nitrous oxide-oxygen or intravenous propofol with suxamethonium.

A randomized double-blinded prospective study was conducted involving 120 ASA 1 or II similarly premedicated adult patients who were allocated into 2 equally numbered groups. All patients were preoxygenated for 3 minutes and given intravenous fentanyl 1.5 m.kg^-1, Group 1 (n=60) received a mixture of inhaled sevoflurane 8 % with 4 litres/ min Nitrous Oxide and 4 litres/ min oxygen for 4 minutes and Group 2 (n=60) received intravenous propofol 2 mg.kg^-1 followed by intravenous suxamethonium 1.5 mg.kg^-1. Intubating conditions were assessed according to easiness of laryngoscopy, position of vocal cords, jaw relaxation, coughing and limb movement. Baseline blood pressure, heart rate and mean arterial pressure were recorded and measured every minute after induction until 10 minutes post-intubation. Adverse events during induction and immediately post-operative were also recorded.

There were significant differences in the overall intubating conditions (p < 0.05) and haemodynamic changes (p < 0.05) between the two groups. The reduction in mean arterial pressure in Group 1 (sevoflurane) was less than 25% of baseline. 23.3% had breathholding during induction with sevoflurane and 28.3% had pain on propofol injection. Incidence of sorethroat, headache, nausea, vomiting, confusion and agitation were not significant (p 0.05).

Induction with intravenous propofol/ suxamethonium provides better condition for tracheal intubation and haemodynamic stability than sevoflurane/ Nitrous Oxide technique.

ORAL (A1 -8)

THE EFFECTS OF SEDATIVE ORAL PREMEDICATION ON OXYGEN SATURATION IN PATIENTS UNDERGOING SPINAL ANAESTHESIA

N. S. Swaran Singh, N. M. Nik Abdullah, K. S. Ng, P. Gnandev, A. Saedah, A. Mohd Nikman, J. Kamarudin

Department of Anaesthesiology, School of Medical Sciences, University Sains Malaysia, Kelantan, Malaysia

Oral sedative premedication is routinely given to majority of patients undergoing anaesthesia. The patients undergoing spinal anaesthesia are monitored with standard ASA monitoring which include pulse oximetry to monitor the oxygen saturation. Oxygen is routinely supplemented to patients undergoing spinal anaesthesia irrelevant of being orally premedicated or not.

To evaluate the effect of oral midazolam as premedication on the oxygen saturation of patients undergoing spinal anaesthesia and not supplemented with oxygen.

A prospective clinical trial was conducted on selected ASA I and II patients who were divided into two groups. Group A (n=70) received oral midazolam 7.5 mg on night and 1 hour prior to surgery. Group B (n=70) were patients from emergency list who did not received any sedative within 4 hours of surgery. Oxygen saturation was monitored during preoperative anaesthesia visit, prior to spinal anaesthesia and at 5, 10, 15, 30, 45 and 60 minutes following spinal anaesthesia. None of the patients in either group received oxygen supplement as a routine. Oxygen at 4 liters.min^-1 via venturi mask was administered when desaturation (oxygen saturation < 92%) occurred at any one time during this period.

There was no difference in the demographic data between the two groups. In group A, five patients desaturated at 10 to 15 minutes after spinal anaesthesia requiring oxygen supplement. In group B, two patients desaturated at 15 to 30 minutes after spinal anaesthesia. There was no significant difference between the two groups.

Oral midazolam did not affect oxygen saturation in patients undergoing spinal anaesthesia. Therefore oxygen supplementation should be based on oxygen saturation monitoring and is not required on routine basis.

ORAL (A1 -9)

A. Zurhayati, A. Saedah, G. Awisul-Islah, J. Kamarudin, J. Nizar, N. M. Nik Abdullah

Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia

To compare the intubation conditions and cardiovascular effects of etomidate/ rocuronium versus propofol/ rocuronium in modified rapid sequence induction of anaesthesia. The adverse events related to the drugs used were also evaluated.

40 patients, ASA I or II, were randomized to two groups - (70 patients / group). They received fentanyl 1.5 µg.kg-¹ followed by etomidate 0.3 mg.kg^-1 or propofol 2.5 mg.kg¹ and subsequently rocuronium 0.6 mg.kg^-1 in both groups. The end of injection of muscle relaxant was designed as time zero. Tracheal intubation was commenced 60 s after injection of rocuronium and intubating conditions were graded on a scale of I to IV by a single intubator. Blood pressure and heart rate were measured before induction and were repeated every 1minute until 5 minutes post induction. Patients were also monitored for excitatory events, nausea and vomiting.

Results

Intubation conditions at 60 seconds were acceptable in 48.6 % of patients in etomidate group and 82.9% of patients in propofol group (p < 0.05). Etomidate produced less change in systolic and diastolic blood pressure as compared to propofol induction. There was higher incidence of excitatory events in etomidate group as compared to the propofol group. There were no differences in the incidence of nausea and vomiting between the two groups.

Propofol provides more acceptable intubation conditions at 60 seconds compared to etomidate when rocuronium 2X ED95 were used. However, etomidate produced less systolic and diastolic blood pressure changes in comparison with propofol induction. Excitatory events was significantly higher in etomidate group.

ORAL (B1 -1)

Biswa Mohan Biswal, Nik Ruzman Nik Idris, Ahmad Zakaria, Nik Min Ahmad, VMK Bhavaraju.

Department of Nuclear Medicine, Radiotherapy & Oncology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan,Malaysia

Brachytherapy is a specialized form of radiotherapy that delivers conformal radiation to the cancer site. This technique was born immediately after the discovery of Radium. However the uses of Barchytherapy have seen many ups and downs due to fear of radiation exposure to the personnel and patients. Since last few decades, brachytherapy has come back to the modern medicine with new safety features and indications. In most modern radiotherapy departments remote afterloaded high dose rate (HDR) brachytherapy is being used for the treatment of solid tumors. Here we would like to present our experience on the uses of HDR brachytherapy in HUSM

From August 1999 to February 2004 we have treated cancer patients using HDR Brachytherapy by microSelectron HDR (Nucletron BV, The Netherlands). Our microSelectron HDR unit is loaded with 10 mCi Iridium source. We used intracavitary, mould therapy and interstitial brachytherapy techniques to treat different cancers. The Brachytherapy was used in cancer cervix, cancer uterus, soft-tissue sarcoma, breast cancer, and other miscellaneous sites. All brachytherapy procedures were evaluated using Plato Treatment planning system as per the recommended brachytherapy rules. We used various fractionation schemes ranging from 2-9 Gy per fractions for 2-6 fractions prescribed at specific reference point. In few cases we used 3D conformal brachytherapy techniques to treat breast cancer and soft-tissue sarcomas

We have already treated 54 cases of Cancer cervix, 26 cases of carcinoma endometrium, 10 cases of early breast cancer, 13 cases of soft tissue sarcomas, and 6 solid tumors from miscellaneous sites. There were no procedural complications. The local control rate was 54% for cancer cervix (all stages), 92% for carcinoma endometrium, 100% for breast cancer and 90% for soft tissue sarcoma. The Bowel and Bladder complications (were very negligible (4%) in gynecological cancers treated by brachytherapy. All patients with breast cancer are alive with acceptable cosmesis at a median follow-up duration of 30 months. Though the local control rate was excellent in soft-tissue sarcomas, but the survival was poor in view of distant metastases at a median duration of 24 months.

High dose radiotherapy is a useful modality of treatment in solid cancers. In our experience, HDR brachytherapy is safe and effective with acceptable morbidity. However we are improving our fractionation schemes to match with the radiobiological parameters.

ORAL (B1 -2)

Shareef BT

School of Dental Sciences, Universiti Sains Malaysia, Kelantan, Malaysia

Grinspan’s syndrome as originally described as a triad of conditions, namely essential vascular hypertension, diabetes mellitus and lichen planus of the oral mucosa. Skin lesions of lichen planus, may or may not be associated with the above medical condition. Lichen planus may be related to drug adverse reaction. A characteristic white lace pattern may be present in the oral mucosa. It is thought that drugs causing lichenoid reactions only uncover the latent disease of lichen planus, or amplify a previous disorder, rather than inducing the disease de novo. A case recently seen is being reported.

A 64-year-old man presented with oral burning sensation for three months. He was on medical treatment for hypertension, diabetic and gout. On clinical examination, erythematous and erosive lesions were presence on both the cheek mucosa with wickham striae radiated from the margins of the erosions. Swab was taken and biopsy was done. He was advised to modify her diet and improved his oral hygience. Local steroid was prescribed. His condition improved slightly. Two months later his condition deteriorated after completing local steroid therapy.

Biopsy result revealed the presence of parakeratotic epithelium with loss of reteridges. The subepithelial stroma is moderately infiltrated by a band of lymphocytes with few macrophages, plasma cells and occasional eosinophils. He was also referred to his physician, who changes his medication.

His condition improved and he is still under follow up.

Based on clinical features, medical history, histological finding and follow up, the lesion was diagnosed as lichenoid drug eruption.

ORAL (B1 -3)

Shahid Hassan, Jafri Malin Abdullah , Phillips Rajan, Zamzuri

Depts. of ORL-HNS & Neurosciences,School of Medical Sciences, Universiti Sains Malaysia.

A.M, a 17 year old Malay boy presented with progressively worsening right sided nasal block of 01 year duration 02 episodes of epistaxis & deterioration of vision recent origin. On examination there was a mass in right nasal cavity extending across the postnasal space on either side. Endoscopy revealed signs of left eye compressive optic neuropathy. An initial differential diagnosis was from chordoma, angiofibroma, pyogenic granuloma & nasopharyngeal carcinoma.

C.T. scan showed hypodense mass in nasopharynx entering into sellar, parasellar, with erosion of pituitary fossa, clivus & middle cranial fossa. MRI confirmed lobulated mass arising from clivus extending into nasal cavity, intracranially compressing upon frontal lobe, temporal lobe & optic chiasma. Cerebral angiogram revealed a nonvascular mass with blood supply coming from both maxillary arteries. HPE confirmed mass consistent with chordoma.

Tumor excision via right maxillary swng, right mandibullar swing, midline tongue split with reconstruction utilizing rectus abdominis muscle & fat was performed. Postoperative complication of rhinorrhea was corrected by lumbar-peritoneal shunt & palatal fistula by secondary closure. Later recovery was uneventful.

Chordomas are slow growing neoplasm derived from notochord & in majority cases are located in nasopharynx eroding the skull base. Confused with chondrosarcoma, tumor is characterized by cells, positive to cytokeratin & epithelial membrane antibodies. Treatment consists of radiotherapy due to tumor extension at presentation & difficult approach to clivus. However combination therapy with surgery, if possible, gives better prognosis.

Excision of extensive chordoma utilizing upper & lower jaw double swing approach in association with neurosurgical expertise is possible with minimal complication.

ORAL (B1 -4)

PROGNOSTIC STUDY OF USING DIFFERENT MONITORING MODALITIES IN TREATING SEVERE TRAUMATIC BRAIN INJURY-A PRELIMINARY RESULTS.

Idris Z, Ghani ARI, Sayuthi S, Awang MS, George J, Prakash RG and Abdullah JM.

Department of Neuroscience, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.

The aims of the study were to prove, the more monitorings we made, the better will be the outcome for the severely head-injured patients.

It was a prospective randomized study, included all traumatic severe head injured cases who had these following criteria: Age of 15 years and above, GCS of less than 9 and CT scan feature did not reveal significant infratentorial pathology.We excluded patient who was on arrival had unilateral or bilateral fixed and dilated pupils believed to be due to on-going herniation, brain dead patient and known history of hemiparesis or any other conditions that lowering the patient’s functional status score.The randomization process was made to allocate to either multimodality or standard modality monitoring. We noted the outcome at 6 months post treatment using the Barthel index score. 44 cases were randomized resulted in 22 cases in each group.

The sixth months outcome between those two groups was not statistically significant (p < 0.85). The univariate analysis showed statistical significant correlation between the outcome and these dependent variables: age(p < 0.004), GCS (p < 0.02), ISS (p < 0.03), Heart rate(p< 0.04), Serum sodium(p< 0.002) and ICP(p< 0.01), however the multivariate analysis failed to reveal any association.

Despite no positive correlation between method of monitoring and outcome, the use of multimodality monitoring in neurocritical care did give the prognostication values and a verification process for the severely head-injured patients’ monitored parameters.

ORAL (B1 -5)

Dr. Vinaykumar Hiremath

Tumor originating from the odontogenic apparatus (tooth forming tissues) are very common in the jaws. Tumors may be benign or malignant they behave very aggressively. Lots of research has been carried out on grouping these tumors in different groups depending on their root of origin (tissue of origin). Sometimes one tumor mass shows pictures of different odotogenic tumors. Then it becomes difficult to assess the histogenesis of the tumor. Here is an attempt to evaluate such a case and hypothesis new histognetic factors for the above said case this paper also provides mathematical way of identifying the odontogenic tumors depending on the tissues which are responsible for tooth formation.

ORAL (B1 -6)

Dr. Kaneez Fatima Amla

School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

Keloids and Hypertrophic Scars (HS) are formed as a result of excessive proliferation of connective tissue during healing process of a wound. Certain races and certain sites of the body are more prone to form keloids and HS. Unsightliness, itching and pain, are the main concern of the patients. Various treatment modalities are in use and all have widely varied response. Recurrence after surgical excision of the keloid/HS is high and depends on cause and the site of the lesion.

To review the role of surgery in hypertrophic scars and keloids.

All newly registered patients with hypertrophic scars and

keloids who attended Plastic Surgery Clinic in 1998 were reviewed.

35 new cases of hypertrophic scars and keloid were registered. 23 had keloids and 12 had hypertrophic scars. 15 patients underwent surgical excision of the lesion. There were recurrences in 3 patients (one complete and two partial) after surgical excision.

It is worthwhile to consider surgical excision in cases of post piercing ear lobe keloids and post burn hypertrophic scars. Close follow up is necessary to detect recurrence and treat it in early phase.

ORAL (B1 -7)

Davendran s/o Tangaya, Nyi Nyi Naing, Farid Bin Che Ghazali.

School of Health Sciences, Biostatistics and Research Methodology Unit, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

Impacted third molars are developmental pathologic medical deformities characteristic of a modern civilization. It is seldom found in medieval populations. Radiographs are an important diagnostic input for assessing and treatment planning of the dental patient, whether symptomatic or asymptomatic. Radiography does in most instances provide more information with regards to the impacted third molars than clinical examination alone, especially of the very important relationship between orientations the roots of the mandibular third molar and the mandibular canal.

The aim is to evaluate the four types of radiographs; Skull, Paranasal Sinuses, TMJ and mandible X-rays which is believed could give the maximum possible coverage of the wisdom teeth presence, if any, it’s impaction and its surroundings. From this evaluation then, the association for the presence of wisdom tooth or impacted wisdom tooth with other parameters governing it (gender, age, caries, orientations and angulations) is found out. Frequency parameters were then evaluated to compare the diagnostic present of wisdom teeth in each type of radiograph to give an answer whether the selected radiological views will provide any valuable information.

A series of 4 different approaches of extra-oral radiographs of different procedures of HUSM radiology archives involving as many as 50 samples for each type of imaging involves; PA of skull, TMJ, paranasal sinuses, and mandible radiographs was selected. The collective data was then transfers to SPSS version 11.0 for statistical analysis testing of association and frequency variables. Fisher exact test was used for dichotomous variables.

There is a very highly significant association between the age group of patients and the presence of wisdom tooth. There is also a significant association between the gender and presence of wisdom tooth in the mandible imaging. Expect for both of this association, all other testing of association gave non-significant association or relationship. Where else for frequency testing, there is few notable, high frequencies observed. Most impacted tooth in this study was unerupted impacted wisdom tooth (mean value 34.9%). Mesioangulation impaction is the most observed impaction (mean value 68.1%). Finally, there is a very low probability of caries presence on this study wisdom tooth.

Holistic radiological imaging of the wisdom tooth requires integration of scientific knowledge based on anatomical-radiological-clinical close linkage and clinical professionalism based on awareness and competence of the subject thus leading to unprecedented knowledgeable health sciences teamwork.

ORAL (B1 -8)

Adil H, Wan Hazabbah WH, Elias H, Liza Sharmini AT

Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia

Ocular trauma remains an important cause of avoidable and predominantly monocular visual morbidity. Closed globe injury is the commonest ocular injury but the least documented.

Aim

USMEIR : Universiti Sains Malaysia Eye Injury registry is aim at reporting the incidence of eye trauma, characteristic of trauma, ocular presentation, management and visual outcome.

A prospective study was conducted involving patient attended eye clinic Hospital Universiti Sains Malaysia from June 2002 to December 2003. Ocular trauma cases were registered and detail description of the trauma was illustrated, which also include the initial management. Classification was based on Birmingham Eye Trauma Terminology (BETT). All cases were then followed up for 6 months.

We reported only the initial presentation of the ocular trauma involving 250 eyes out of 247 patients with 79.8% (193 eyes) involved in the closed globe injury. Mean age of patients is 29.27 ± 19.12 years. 81.8 % are males. 83.8% of them are not using any form of eye protection during the injury. Work related injuries are reported in 14.6%. Most of them are welder (47.5%), followed by mechanic (22.5%), grass cutter (10%), carpenter (7.5%) and farmer (2.5%). Home is the most common place of injury (36%), followed by industrial premises (16.6%) and street and highways (14.2%). Cornea (75.3%) is the most affected tissue. Corneal abrasion is the most common type of injury involving the cornea, in which 21.4% associated with corneal foreign body. 67% of affected eyes presented with good vision (6/6 to 6/9).

The use of protective glasses in working area need to be emphasized to prevent severe eye injury. Education and self-awareness regarding safety measures and the need for safe environment must be stressed not only in the industrial premises but also at home.

ORAL (B1 -9)

Shahid Hassan, Hashimah Binti Ismail

Depts. of ORL-HNS, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

During the course of radiotherapy as the management of head and neck tumors, the temporal bone often falls within the treatment field and both the inner and middle ear may receive the full tumor radiation dose.

Nasopharyngal Carcinoma (NPC) is not very uncommon particularly in Chinese patients in Malaysia. In patients with nasopharyngeal carcinoma (NPC), deafness sometimes occurs following radiotherapy. It is usually conductive but may be sensorineural. Many published studies on effects of radiation on ears have shown conflicting results.

To study the effects of radiotherapy on hearing threshold of NPC patients.

A prospective study to know the effect of radiotherapy on hearing in NPC patients was carried out on 30 patients who attended ENT and combined oncology clinic HUSM during 1999 to 2001. These patients had pure tone audiogram performed before receiving radiotherapy. Tympanometry was used to confirm middle ear effusion.

Radiotherapy was delivered via linear accelerator in 2Gy fractions for four and a half weeks to a total dose of 6070 Gy. Pure tone audiogram was repeated at least six months after completing treatment.

Twenty-two males and three females completed the study. Before the initiation of radiotherapy, otitis media with effusion was observed in 13 ears of which one resolved spontaneously following radiotherapy. On the other hand, 4 ears with no prior middle ear effusion developed it after radiation. This study also showed a significant increase in mean hearing threshold at both low and high frequencies (p<0.05) after radiotherapy. At low frequencies, the increment in mean hearing threshold was observed more at 0.5kHz (p<0.00) and at 8.0kHz for high frequency (p<0.002). Nine ears with middle ear effusion underwent grommet insertion and none developed otorrhoea after radiation treatment.

We establish that radiation which is the mainstay of treatment in NPC patients could result in sensorineural hearing loss and middle ear effusion.

ORAL (C1 -1)

Dr. Md. Nurul Islam

School of Dental Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

It is generally believed that firm cemento-dentinal attachment is maintained by the intermingling of dentinal and cemental fibrils and by mineral reinforcement in human and rat teeth. Previous studies, using scanning electron microscopy have established that fibril intermingling is found only in some regions of the cemento-dentinal junction. Prolong maceration with NaOH breaks down the junction in spite of the fiber intermingling. The purpose of this study was to observe CDJ histochemically and provide information about mineral content of the attachment.

Method

Decalcified blocks were made from male Wistar rat maxilla. Serial 5µm sections were cut mesio-distally and stained with H/E and silver impregnation. For proteoglycan demonstration, PAS and toluidine blue (pH 6.0) were employed. Some sections were used for digestion test using 1% testicular hyaluronidase.

Results

In both acellular and cellular cementum, the cementodentinal junction was a layer about 1µm thick. It was intensely stained with hematoxylin, not impregnated with silver, and found PAS and toluidine blue positive. After treatment with testicular hyaluronidase, CDJ lost its affinity for toluidine blue.

Conclusion

This study suggests that cemento-dentinal junction is full of mineral content and is a fiber-poor structure. The mineral content is proteoglycan in nature. It also suggests that the mechanism of attachment between dentin and cementum is mainly by proteoglycan adhesion and not by collagen fiber intermingling.

ORAL (C1 -2)

Zury Azreen Bin Azizul Rahman, Farid Bin Che Ghazali, Syed Mohsin Sahil Jamalullail,

School of Health Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

Sea cucumber known as gamat in the Malay language or haisom in Hokkien or becher-de-mer, is a remedy derived from a marine animal closely related to starfish and sea urchins. It is also called brunok, bat or bala in various South East Asian Languages. The extracts from sea cucumber have been used as a therapeutic remedy by the Malays and are well known in most local ethnic communities especially in South East Asia. It is claimed to reduce pain in ailments of inflammatory origin or stiffness in arthritis sufferers.

Aims and purpose of the study

The purpose of this study was to highlight the presence of toxicity of selected sea cucumber extracts, namely the Holothurian spp and Stichopus spp on Swiss albino mice.

Materials and methods

Fresh sample of both type of the sea cucumber species were harvested at the Perhentian Island off the coast of Terengganu, Malaysia. Samples were preserved in seawater prior to laboratory processing and subsequent experimentation. Organic and non-organic solvents were used to extract samples from body fluids and tissues of the sea cucumber. Their body fluids were collected during the process of dissecting. Whereas for its tissue, samples were initially dried in a hot air oven then ground into powder and subsequently extracted by organic or non-organic solvents. The resultant materials were then filtered, saturated and finally freeze-dried. From the freeze-dry process, 8 samples of body fluids and body tissues extracts of Holothuriidae and Stichopodidae were produced. Dosage of extracts was calculated based on the amount of powder obtained, volume of solvent used and body weight of the experimental mice. 10mg/kg of extract were then administered to the mice intraperitoneally. CNS effects were observed including behavioral changes and analgesic properties were observed using the tail flick and hot plate test methods. The behavioral study was undertaken over a 4 hours observation period.

Results

Results obtained revealed that CNS disturbances were observed in mice of both the sea cucumber extracts. The observed effects included changes in attitude, restlessness, sedation, tremor, paralysis, pilo-erection, passitivity and jerky movements. Extracts of sea cucumber showed some sedative effect. Stichopodidae body fluid showed the most severe sedative effect. Holothuriidae body fluids have a positive analgesic effect. All the samples showed negative analgesic results when tested using the hot plate test.

Conclusion

The study revealed that extracts of sea cucumber may have some sedative effect while only one extract, that is the body fluid of Holothuriidae showed analgesic properties.

ORAL (C1 -3)

Muzammil Ullah*, Marina Yu Kapitonova** & B.S Rathna**

*School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian & J.N. Medical College, Aligarh Muslim University, Aligarh, India, **School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

Chromatolysis has been induced experimentally by cutting the nerve in a surgical operation by many workers to locate the motor neuron somata of many cranial and spinal nerves (including phrenic nerve) in many mammalian species.

Objective

To study the light microscopic structure of chromatolysed neuron somata stained with thionine and to localize them after an injury of the phrenic nerve in dog.

Methodology

Eight dogs representing both sexes were used in the study. Under general anaesthesia (Nembutal sodium at a dose of 30 mg per Kg. weight intravenously), the right phrenic nerve was exposed in the neck, cut and a part of it removed to prevent re-union. The left side acted as control. The animals were sacrificed 28 to 35 days after operation, circulation flushed with normal saline and perfused with 10 % formal saline at a pressure of 125 mm Hg. The 4^th, 5^th, 6^th, 7^th and 8^th cervical segments of the spinal cord were removed by dorsal approach, separated from each other and embedded in paraffin. Their serial frontal sections were cut at 50 micrometers and stained with thionine for Nissl granules. The sections were examined microscopically to identify the chromatolysed neuron somata. From the tracings of the frontal sections, a map of the longitudinal extent of the chromatolysed neuron somata and their relations with the cell columns of the ventral grey horn were reconstructed at the middle of fifth cervical (C-5), middle of sixth cervical (C-6) and at the cranial part of the seventh cervical (C-7) segments of the spinal cord.

Results

It was observed that the chromatolysed neuron somata were located in the central group (often called ‘phrenic nucleus’ by many authors) of the ventral grey horn of spinal cord. Most of the chromatolysed neuron had a swollen soma (cell body) with an eccentric nucleus and absence of Nissl granules. In some neuron somata a typical chromatolysis was not observed but there were retrograde change in which the Nissl granules (Nissl substance) formed a homogenous ring around the centrally placed nucleus with a clearer zone of cytoplasm between this and cell membrane.

The central goup was found to be a longitudinal column of neuron somata with its longitudinal axis lying almost parallel to the longitudinal axis of the spinal cord. The central group extended longitudinally from the caudal end of C-4 (fourth cervical segment) or cranial end of C-5 to the caudal end of C-6 or cranial part of C-7. The group occupied an intermediate position between the ventrolateral column and ventromedial column of the ventral grey horn. Its caudal end was found to merge with the ventromedial column.

Conclusions

The motor neuron somata of the phrenic nerve in dog are identified on the basis of chromatolysis after an injury of phrenic nerve. They are located in a well-defined longitudinal cell column of the ventral grey horn of the spinal cord, the ‘phrenic nucleus’ (or phrenic column), occupying an intermediate position between the ventrolateral and ventromedial cell columns. The caudal end of this column was found to merge with the ventromedial column. The column extends longitudinally from the caudal end of C-4 or cranial end of C-5 to the caudal end of C-6 or cranial part of C-7.

ORAL (C1 -4)

Eng K. K., Md. Rafiquzzaman and S. S. J. Mohsin

School of Health Sciences, Health Campus, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

Research is continually going on in search of an ideal natural antioxidant and its potential source. Natural antioxidants are capable of destroying free radicals in the body and thus help to keep the body’s oxidative stress in balance. They are also thought to help in preventing degenerative diseases. The practice of eating ‘ulams’ (parts of plants consumed as salad) by the Malays is ancient. Though several studies have been performed on antioxidant properties of several Malaysian plants and ‘ulams’, the ‘ulams’ native to Kelantan have not been given due attention.

Objectives

The objective of the present study was to evaluate the antioxidant activity of six ‘ulam’ species that are found in the state of Kelantan, Malaysia.

Methodology

The ‘ulam’ species used in the present study were Barringtonia sumatrana (Putat), Pithecellobium microcarpum (Kerdas), Syzygyium poliantheum (Serai kayu), Psophocarpus tetragonolobus (Kacang kelisa), Garcinia atnoviridis (Pucuk gelugur), and Stenochleana palustris (Midin). The methanolic extracts of the ulams or the BHT (2, 6-di-tert-butylhydroxytoluene) standard at 0.02 mg/mL concentration level was allowed to inhibit the Fe(III)(NTA) ₂ catalyzed breakdown of the methyllinoleate hydroperoxide (MLOOH). The percent of inhibition of MLOOH breakdown was taken as the antioxidant activity of extracts.

Results

Out of six methanolic extracts of the ‘ulams’, four extracts showed antioxidant activity and the remaining two did not. The decreasing order of antioxidant activity was observed as Barringtonia sumatrana Syzygyium poliantheum Psophocarpus tetragonolobus Stenochleana palustris. The antioxidant activity of Barringtonia sumatrana and Syzygyium poliantheum were relatively high i.e. 100% and 94.63% respectively, which indicated that these two species of ‘ulams’ are potentially good sources of antioxidant.

Conclusion

Barringtonia sumatrana and Syzygyium poliantheum were identified as good sources of antioxidant. It is suggested that further investigation of these two ‘ulam’ species are relevant and can be of importance in dietary control of diseases.

ORAL (C1 -5)

V.Gopalakrishnan and Chan Guan Tiong

Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia

Viral infections of the central nervous system may result in clinical syndromes like aseptic meningitis, encephalitis, and myelitis. These are often difficult to diagnose because conventional laboratory methods, such as viral culture and serology, are time consuming and unsatisfactory. Hence a rapid technique should be employed to detect the etiologic agent.

Objective

To standardize reverse transcriptase(RT) multiplex PCR aimed to detect viral etiology in CNS infections.

Methodology

An RT multiplex PCR aimed to detect viral etiologies, in CNS infections, enterovirus, herpes simplex and varicella zoster viruses, has been standardized. Three sets of primers were been employed for the standardization of the assay. The amplification of target sequences was qualitatively read by running an agarose gel by look for presence or absence of amplicons.

Results

The above said RT multiplex PCR was standardized. Sensitivity of the PCR is being ascertained.

Conclusions

The RT multiplex PCR can be used to detect herpes, varicella and enteroviral infections.

ORAL (C1 -6)

Gurjeet Kaur¹, Rosli Ismail², SK Lee², S Subathra², Noorani Ahmad³

¹Advanced Medical and Dental Institute, Universiti Sains Malaysia, Penang, Malaysia; ²Department of Pathology, Hospital Pulau Pinang; ³School of Mathematical Sciences, Universiti Sains Malaysia, Penang, Malaysia

Breast cancer is the most common cancer in Malaysian women. This study aimed to determine the histopathology of breast carcinoma in Hospital Pulau Pinang (HPP) and study the correlation between pathological variables of invasive ductal carcinoma (IDC) with lymph node metastasis.

Method

Demographic data was obtained from histopathology records of all breast cancer cases diagnosed at HPP in 2003. The association between tumour size, histological grade (acinar formation, nuclear pleomorphism, mitotic count), ER and c-erbB-2 status with lymph node metastasis was tested by chi square.

Results

There were 62 cases (1 male) of invasive carcinoma (57 IDC, 2 invasive lobular carcinoma; 1 each of mucinous, invasive papillary and inflammatory carcinoma) and 12 cases of ductal carcinoma in situ. The median age of females with invasive carcinoma was

52.5 years and racial breakdown was 38 Chinese, 17 Malay, 5 Indian and 1 Indonesian. The mean tumour size was 3.45 cm with 80% of tumours larger than 2 cm. Histologic grade 3 comprised 48.9% of cases. ER and c-erbB-2 staining was positive in 20/43 and 11/43 cases respectively. Lymph node metastasis was detected in 22/39 (56.4%) patients who underwent axillary clearance. There was a positive correlation between nuclear pleomorphism of tumour cells and lymph node metastasis but no correlation between size of tumour, histological grade, acinar formation, mitotic count, ER and c-erbB-2 status with lymph node metastasis.

Conclusion

The majority of patients with invasive breast carcinoma in HPP were Chinese and presented at a locally advanced stage with lymph node metastasis. Tumour nuclear pleomorphism correlated with lymph node metastasis.

ORAL (C1 -7)

¹Asma Hayati Ahmad, ²Azhar Ahmad, ³Zalina Ismail, ⁴Myo Than

¹Department of Physiology, ²Department of Chemical Pathology, School of Medical Sciences; ³Department of Physiology, School of Allied Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia. ⁴Department of Anatomy, Perak Medical College

Induction of fos-like immunoreactivity (FLI) in the spinal cord due to pain has been well studied. However, few have looked into the effects of stress-induced analgesia on FLI in the spinal cord. We used acute swim stress to see its effects on FLI in the spinal cord and its modulation of pain induced by the rat formalin test.

Objectives

To see the effects of acute swim stress on fos-like immunoreactivity (FLI) in the rat formalin test.

Methodology

Adult male Sprague-Dawley rats were assigned to 2 groups, i.e stressed and non-stressed (n=8 for both groups). Rats in the stressed group were subjected to acute swim stress for 3 minutes. After 10 minutes, rats from both groups were injected with 0.5ml of 1% formalin over the right hind paw and the formalin test score was recorded for 60 minutes. Two hours after formalin injection, five rats from each group were sacrificed with an overdose of sodium pentobarbitone i.p., perfused with PBS followed by 4% paraformaldehyde in PB 0.1M, and the spinal cord dissected at the L4-L5 segments. 30_m sections were cut using cryostat and immunohistochemistry for FLI was performed using free-floating method. Sections were then mounted on slides, viewed using an image analyzer and the fos-like immunoreactive neurons were counted.

Results

Results were analyzed using repeated measures ANOVA for formalin test and one-way ANOVA for fos-like immunoreactivity (FLI). For formalin test, acute swim stress produced significant analgesia (p<0.01). The non-stressed rats displayed induction of FLI over the ipsilateral (injected) side of the spinal cord only (p<0.001) while the stressed rats had FLI induced bilaterally (p<0.01). However, for the stressed rats, FLI induction on the ipsilateral side was significantly lower than the FLI induced on the ipsilateral side of the non-stressed rats (p<0.01).

Conclusion

Acute swim stress caused induction of FLI in the spinal cord but in the presence of pain, acute swim stress caused reduction of FLI induction. This phenomenon is believed to be due to the endogenous modulation of pain in the spinal cord.

ORAL (C1 -8)

Wan Malihah Wan Ali, Harbindar Jeet Singh

Department of Physiology, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

The aim of the study was to ascertain if there was any difference in the levels of Endothelin-1 (ET-1) and Nitric Oxide (NO) between feto-placental tissues from normotensive pregnant women (NTPW) and women with pre-eclampsia (PE).

Introduction

The pathogenesis for pre-eclampsia remains incompletely understood but overwhelming evidence points to the presence of a placental abnormality contributing to placental insufficiency in pre-eclampsia. An imbalance of vasomotor factors in the placenta of women with PE is hypothesised.

Methodology

Supernatants of homogenates from fresh, vaginally delivered amnion, chorion, and placenta from 12 normotensive and 12 pre-eclamptic women were measured for ET-1 and NO. ET-1 levels were measured using RIA whereas NO were measured using the Griess reaction technique.

Results

There was no significant difference in the ET-1 levels in the amnion between the two groups. However, mean ET-1 levels in the chorion and placental cotyledon were significantly higher in placentae from women with PE when compared to its levels in similar tissues from NTPW (p<0.05). There was no significant difference in the levels of NO or in the activity of NOS between the amnion, chorion and placental cotyledon from NTPW or PE or between corresponding tissues from both the groups. There was also no significant correlation between the levels of ET-1 and NO in the placental cotyledon in either of the groups.

Conclusion

Our observations appear to suggest that ET-1 is significantly elevated in the chorion and placental tissues from women with pre-eclampsia when compared to similar tissues from normotensive women. The absence of any significant difference in NO between tissues from both the groups, suggest a preponderance of vasoconstrictor activity in the intra-placental milieu of women with PE. This may, to an extent, be responsible for the hypothesised placental insufficiency in PE.

ORAL (C1 -9)

V. Srinivasan

Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

Affective disorders involves disruption of intrinsic biological rhythms, like sleep-wake cycle, body temperature rhythms, hormonal rhythms, rest-activity cycle etc. Some of these are phase advanced both in endogenous depression as well as in bipolar affective disorders where in patients exhibit both manic and depressive phases during the course of their illness. Melatonin, the chief hormone secreted form the pineal gland has been shown to be of major importance for establishing the correct phase position of various bodily rhythms, the disturbance of which only causes INTERNAL DESYNCHORINIZATION, the major reason for the occurrence of bipolar affective disorders. Some of the bodily rhythms are phase advanced in both endogenous depression as well as in Bipolar affective disorders. In contrast to this, bodily rhythms are phase delayed in seasonal affective disorders (SAD) or winter depression. Melatonin being a CHRONOBIOTIC has been used successfully to set right the disturbed biological rhythms in patients suffering from affective disorders and is being used as a therapeutic tool for treating these disorders. In addition to this, bright light also is being used successfully to treat endogenous depressives, bipolar patients and patients suffering from winter depression. Since light acts mainly by altering both rhythm and amplitude of melatonin secretion, and is able to set right the disturbed bodily rhythms, an interaction between light and melatonin is very important not only in understanding the pathogenesis of affective disorders but also in employing LIGHT as a useful therapeutic tool in treating affective disorders. Recent aspects on this line of research will be discussed.

ORAL (A2 -1)

Rani Samsudin, Gopal Nair, Lin Naing, Ab. Hakim Basir, Nizam Abdullah

School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

The purpose of this study was to determine the dimensional accuracy of the anatomical replicas produced by Rapid prototyping technology using stereolithography apparatus.

Methods

Computer tomography images were captured from four dry normal adult human skulls. The resultant 2-D images were stored in Digital Imaging and Communications in Medicine (DICOM) format. The segmentation of the images was done by using MIMICS software. The slice files were then exported to a stereolithography apparatus (SLA) to produce the replica of each skull. Eight linear measurements were repeatedly made between identified landmarks on each of the original skull and its replica model using an electronic digital caliper. Each of the linear measurements was repeated 5 times and the average was taken to determine the absolute difference and percent difference between the original skull and its replica model.

Results

The overall absolute difference between the four human adult skulls and its replica models was 0.23 mm with a standard deviation of 1.37 mm. The percent difference was 0.08% with a standard deviation of 1.25%.

Conclusion

The degree of error established by this system seems reasonable in clinical applications when these models are used in the field of dental surgery for surgical treatment planning.

Keywords : Rapid prototyping, Stereolithography apparatus, 3-D medical model

ORAL (A2 -2)

V.K.Gopinath¹, Wan Abdul Manam Wan Muda², C.S. Kavitha²

¹ School of Dental Sciences; ² School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

Cleft lip and palate (CLP) infants present with a number of problems. Among them feeding difficulties are relatively higher. These infants are undernourished and have compromised growth compared with their normal counterparts. The Objectives of this study were to assess the nutrient intake and feeding methods of children with CLP and that of normal children.

Methods

A total of 221 children from birth to six years belonging to both sexes with CLP (60 children) and normal (161 children) were selected. The CLP and normal children were divided into three subgroups according to age. They are subgroup I : birth to 2 years, subgroup II : 2 to 4 years and sub group III : 4 to 6 years. The practice of feeding the infants (breast, bottle, spoon) in subgroup I was assessed by using standard piloted questionnaires. The nutrient intake was evaluated in subgroup II and III using a 24-hour diet recall method.

Results

showed mothers of the normal babies had a significantly more positive attitude (p < .01) towards breast-feeding. When compared to normal children the nutrient intake of CLP children was not significantly different.

Conclusion

It can be concluded that parents with CLP children were more interested in their child’s nutrition, because of the medically compromising condition of the child.

Only 40% of the mothers with CLP infants were successful in breast-feeding their infants in contrary to the 90% of the mothers with normal infants.

ORAL (A2 -3)

¹Abu Rub N, ¹Burhanuddin A, ¹A. R Samsudin, ²Nizam A.

¹School of Dental Sciences, ²School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.

The use of palatal expansion appliances has been claimed to produce a continuous force, which is capable of expanding the maxilla of cleft palate patients who have deficient maxilla. The aim of this study was to evaluate and compare the palatal changes using different arch expansion appliances in patients with cleft palate with or without cleft lip that were treated at the Combined Cleft lip & palate Clinic in Kelantan, and also to correlate these changes at various age of application of these appliances.

Materials and Methods

This is a retrospective record review study involving forty-nine oral cleft patients who underwent palatal expansion at combined clinic in Kelantan. 12 patients had used Pre-Surgical Orthopedic Plate (PSOP), 11 patients used Upper Removable Appliance (URA), 11 patients used Quad-helix (QH), 3 patients used Rapid Maxillary Expansion (RME), and 12 patients used Upper Fixed Appliance (UFA). Pre and post treatment study models were analyzed for changes in inter-tuberosities width, inter-canines width, palatal length and palatal depth using fowler-sliding caliper. Data were analyzed using SPSS 11.0

Results

Results revealed that all expansion appliances were capable of expanding the maxilla. Age did not influence the total amount of expansion in all the appliances except in RME group; the inter-tuberosity width increased as age increased. However, palatal depth in UFA group decreased as age increased.

There was no significant difference in palatal changes between URA, QH and UFA expansion appliances, except the inter-tuberosity width.

Conclusion

In conclusion, all commonly used appliances were suitable for arch expansion in all ages. RME tended to produce more lateral expansion in adolescent and UFA tended to produce more shallow palate in children.

© Copyright 2004 - Malaysian Journal of Medical Sciences