1st Asean Conference on Medical Sciences18th – 21th May 2001Held at the Renaissance Hotel Kota Bharu, Kelantan, Malaysia.

Until the early 1980s the standard treatment for the malignant bone tumors of the extremities was amputation at or above the joint proximal to the tumor. After surgery a period of watchful waiting ensured the results, and then more than two third of the patients suffered pulmonary metastases and eventually died with their disease. The recent advances have improved the treatment results dramatically in the patients with high-grade bone and soft tissue sarcomas. Radiographic imaging techniques such as CT, MRI, bone scan and etc have improved, and enable us to better define the anatomic confines of the lesion and those provide critical information in deciding whether amputation is necessary or limb salvage surgery is possible. Chemotherapy has improved most dramatically. Traditionally, chemotherapy was considered to ineffective for the treatment for the sarcomas. However, recent many clinical trials have reported adjuvant chemotherapy very useful to eradicate micrometastatic disease and improve survival. Adjuvant chemotherapy has remarkably increased overall survival. The survival rate with surgery alone for non-metastatic high-grade osteosarcoma during the 1970s was 20%, however it rose to almost 70% with adjuvant treatment regimens in the 2000s. Moreover chemotherapy can be administered in early stage of the treatment (pre-operatively) to eliminate micrometastasis and induce the tumor down staging, and enforce local control and enable us more effective limb salvage surgery. In the multi-institutional study by Simon et al. at 1986 the survival rate of the patients with osteosarcoma of the distal femur was 55% at five years. There was no significant difference of the survival rates in the patients who had hip disarticulation, above-knee amputation, or a limb salvage procedure. The main concerns associated with limb salvage surgery for high-grade osteosarcomas are safety and adequacy of functional restoration. Regarding the issue of safety, it was confirmed by the Simon’s report. Regarding the issue of functional restoration, limb salvage produced better functional status to amputation and prosthetic fitting. When deciding which reconstructive procedure is best suited after resection, the surgeon must consider thereconstruction in a young patient with benign tumor. The requirement of the wide resection with normal tissue cuff often leads to extensive resections causing considerable problems of reconstruction. At present, the methods most widely used in clinical practice seem to bone transplantation, either autograft or allograft and prosthetic replacement. Autogenous bone grafting represents beyond doubt the most physiologic procedure for reconstructing skeletal defects. However donor sites of the autograft for extensive structural defect are limited. And when using autogenous grafts with a major cortical component in the reconstruction of long diaphyseal defects, late fatigue fractures often occur in spite of grafted bone healing. When large segments of bone need to be replaced, the vascularized bone transfer is available: the iliac crest and the fibula. Although microvascular surgery may improve the results, autogenous bone graft for major structural defect due to extensive resection of the malignant tumors is difficult to offers congruent skeletal substitution. Another important limitation of autogenous bone grafting is the amount of material available. Utilization of tumor replacing segmental mega-prosthesis for hip, knee and shoulder supply an effective means of restoring skeletal continuity while maintaining the function of the neighboring joint. Prosthetic reconstruction restores excellent function and usually leaves the patient well satisfied because of the preservation of movement. While prosthetic reconstruction may seem best indicated in older patients who have less functional demands on the implants, it has been used to a great extent in young patients with life threatening sarcomas because of the advantage of immediate functional restoration and minimal morbidity. While the early results have been satisfactory, concerns for long-term prosthetic function have limited widespread acceptance. Many megaprostheses are implanted each year with good results. However, complications are frequent, resulting into re-operation and, at times, even amputation Complications may occur early or late. Early complications include wound necrosis, infection, dislocation, prosthetic instability, neuropraxia, and vascular complication. Late complications include hematogenous infection, fatigue fracture, prosthetic loosening, prosthetic dislocation, polyethylene wear, and local recurrence. Roberts et al reported a 64% 7year cumulative success rate for distal femur reconstruction. Infection (7%) and loosening (6%) were the most common complications. Prosthetic survival for various anatomical sites was inversely proportional to patient’s survival with event free prosthetic survival of proximal femur reported at 89%, distal femur at 59%, and proximal tibia at 54%. This relatively high frequency of complications is not unexpected, given the length and nature of the surgical procedures and the high demand placed on the implants. The early complications of limb salvage are usually related either to intra-operative technical problems or to postoperative complications involving soft tissues defect. The late complications are related to prosthetic failure or local recurrence. The transplantation of large bulk allografts initiated by Laxer who reported his experience with partial or total knee joint replacement using allogeneic tissue for traumatic joint loss in 1906. However, it was not popularized due to the inability of storing the allograft tissue for future use. In 1966, Parrish reported that freezing transplantable tissue to–40 degrees would not only preserve the tissue but also decrease its immunologic competency. Further reports by many authors in 1970s firmly supported the potential use of this material in orthopedic reconstruction. Large structural allografts can be considered intercalary, allograft prosthesis composites and osteoarticular allograft. The advantages of allografts include the lack of any donor site morbidity, the capacity to shape the tissue to actual deficit, and the ability to advance peri-articular soft tissues into the allogeneic tissue to allow for not only greater inherent stability but also greater functional outcome. Allograft offers a means of obtaining almost unlimited amounts of material for skeletal reconstruction. The disadvantages of allografts include the lack of donors, continued and evolving quality control issues, costs, transmission of disease, and the high complication rates with infection, non-union, fracture and resorption. Non-union and fracture of the allograft are attributed mainly to low osteogenic capability. Osteoarticular allograft includes an inordinately high rate of articular cartilage collapse, subsequent degeneration and instability of the joint leading to additional surgical procedures. Osteoarticular allografts have met with inconsistent results. The majority of these reconstruction have utilized tissue stored at – 70 degrees for months prior to its subsequent transplantation into the recipient. Under the most ideal circumstances including attempts at cryopreservation with 10 to 20 % DMSO and a slow freezing process, cartilage viability remains at maximum 30%. Additionally the lack of congruence between the donor and the recipient has lead to altered stress distribution within the reconstructed joints precipitating premature degenerative arthritis. Due to the lack of the viable allografts are simulating a Charcot joint with its propensity to instability and collapse. The relatively low success rate of the osteoarticular allograft is dependent on the maintenance of the articulating segment of the allograft. With intercalary or allograft prosthesis composites, generally the success rates have ranged from 85 to 100 %. Osteoarticular allografts, however, have under the best of circumstances 50 to 60% successful outcome. Given the inconsistent results with osteoarticular allografts using fresh frozen tissue most surgeons now recommend using allograft prosthesis composites. The advantage of using allogeneic tissue with prosthesis is that it does allow for reconstitution of bone stock. It affords the opportunity of reconstruction periarticular soft tissues for stability and function, which is not possible with large tumor prosthesis. Additionally, the possibility of using less constrained prosthetic components is attractive by minimizing or at least deferring implant failure. Allograft prosthetic composite has become the reconstruction of choice for periarticular tumors in the lower extremity. At the hip this allows reconstitution of abductor mechanism and at the knee the extensor mechanism by sewing allogeneic tissue into host soft tissue. Bone union at the allograft host junction often is delayed and incomplete yet functional. Unlike autogenous reconstruction, allograft reconstruction mandate a longer rehabilitation program with nominal stresses being placed through the reconstruction and return to activities recommended only when radiographic evidence of union has occurred. Continued evidence of non-union often necessitates secondary autogenous bone graft, sometimes the use of vascularized bone graft. The recent studies for allografting has supported the presence of all three immune mechanisms including humoral antibodies to donor tissue antigens, cell mediated immunity to donor antigens and antibody dependant cell mediated cytotoxicity. The subsequent cartilage damage of the osteoarticular allograft is initiated by direct injury by cytotoxic antibodies or lymphocytes and indirectly by inflammatory mediators and enzymes including collagenase, proteoglycanase, and plasminogen activating factor. Although freezing tends to alter the immunologic response, it does not eradicate it. The current techniques of cryo-preserving articular cartilage are insufficient and the only way to assure success of such a reconstruction was to use fresh antigen-matched to recipient, osteoarticular allografts. The goal of reconstruction is to restore as much as function as possible. The specific choice of the reconstructive techniques for malignant bone tumor can be allograft. Viral hepatitis A, B, C, D and E are important public health problems in the ASEAN region. However, hepatitis B and C are the main concerns because of their severe and frequent sequelae such as chronic hepatitis, cirrhosis and hepatocellular carcinoma (HCC). About 2 billion people have been exposed to Hepatitis B virus (HBV) worldwide. Of the estimated 50 million new cases of hepatitis B virus (HBV) infection diagnosed annually, 5–10% of adults and up to 90% of infants will become chronically infected. Conservative estimates are that, there are about 350 million individuals chronically infected with HBV and it is estimated that 75% of these are found in Asia . Indeed HBV is the leading cause of chronic hepatitis, and up to 25% of these individuals will succumb to cirrhosis and HCC. The difference in prevalence rate is due to the method of acquisition of HBV infection which varies geographically. Perinatal transmission is most common in high prevalence areas such as South East Asia and China, while sexual contact and percutaneous transmission in adults are most common in the United states, Canada and Western Europe. The transmission of virus at time of birth, inducing HBV infection in 90%–95% of exposed neonates, in turn produces persistent infection in 90% or more of those infected is responsible for the high prevalence rate of about 8–20% of chronic HBV infection among Asians . This phenomenon begins to decline as the exposed individual increases in age, falling to about 20% among exposed children and 1–10% in exposed adults . Hence the control programmes for HBV in SEA are different from those in other areas. Countries such as China (mainland and Taiwan), Indonesia Japan, Korea, Malaysia, Singapore and Thailand have integrated hepatitis B vaccination in their childhood immunization programme. In Taiwan, the rate of HBsAg positivity dropped from 10% to 0.9% after 10 years of universal infant immunization and catchup immunization of preschool children. In Thailand, a 4 year universal infant immunization programme was evaluated and it was found that HBsAg seropositivity decreased from 5.4% to 0.8%. In Singapore, the prevalence of HBsAg has dropped and a recent survey reported a seroprevalence of 4.5% in unvaccinated individuals over 5 years of age and the absence of HBsAg in vaccinated individuals in the same age group. In Malaysia, since we do not routinely screen our antenatal mothers, mass immunization of infants was started in I989 and the HBsAg seroprevalence is expected to drop from the current reported figure of 3–5%. The natural history of HBV infection has been well documented with the recognition of the three phases in chronic HBV infection. However, effective treatment options are limited and the prognosis of end stage liver diseases (ESLD) is poor. Thus the prevention of HBV infection is still therefore through vaccination. Among the evolving issues regarding HBV immunization includes the continued evaluation of duration of protection to determine future recommendations concerning booster doses, evaluation of combination vaccines, development of strategies to achieve high rates of adolescent vaccination, and evaluation of long term protection afforded by new vaccines, especially those with schedule of fewer than 3 doses The prevalence of hepatitis C (HCV) infection in the general population is low, ranging from 1–3% approximately 170 million people. In Malaysia, the prevalence of HCV infection in the general population is about 1% and accounts for about 5.8% of chronic hepatitis. As in other areas of the world, the prevalence of HCV infection in the ASEAN region is highest in high risk groups i.e. blood transfusion intravenous blood drug abuse and plasma donation. At present there are no completely satisfactory means of prevention of hepatitis C. Non specific public health measures such as multiple blood screening with sensitive reagents, use of blood from voluntary donors, education to stop sharing needles, syringes, use of disposable equipment for plasmaphoresis and treatment of infected individuals are partially effective . Hence, ultimately an HCV vaccine will be needed to control this important disease. HCV poses several obstacles to the development of an effective vaccine because it cannot be propagated efficiently in cell culture and lack a small animal model of HCV infection . HCV is an RNA virus that tends to mutate rapidly and immune pressure appears to induce mutations that escape neutralization by antibody and recognition of specific T cells. Furthermore, there are six genotypes and more than 50 subtypes of HCV and immune responses to one genotype may not provide cross-reacting immunity to a heterologous genotype. In addition to this, unlike HBV infection, the natural history of HCV infection is not yet fully established as the initial onset of infection is usually devoid of signs and symptoms, the progression from acute to chronic hepatitis is extremely common, that the disease course during the chronic phase is usually not accompanied by symptoms and that the duration of development of ESLD may exceed 30–40 years. It is comprehensible that it is difficult to accurately determine the outcome of a condition that begins silently, advances subtly and remains devoid of symptoms during much of its course. Hence for HCV infection, more research regarding the natural history is required with particular emphasis on defining in more complete terms the pathogenesis of chronic HCV infection, the factors that promote progression and factors of value for the individual that predict long term outcome. The aim of this study is to review our local experience of tissue transfer in trauma-related cases and to assess the outcome and benefits of this mode of treatment. We retrospectively review and assess all consecutive patients who underwent tissue transfer related to trauma during the period of August 1997 to January 2001. A total of 26 patients had been operated during a period of 29 months. Patient age ranges from 1 to 62 years. The traumatic sites involved are head (2), upper extremity (4) and lower limb (15). One patient was treated early (3 months). In the delayed cases the patient had underwent an average of 2 procedures while in the late group there were an average of 3.5 procedures performed before the final surgery. After tissue transfer there is an average of one revision procedure. There were no treatment failures. The complications were nil in the early group, four in the delayed group and one in the late group. The average duration of surgery was 6.86 hours for the delayed group and 12.7 hurs for the late group. The mean hospital stay was 7 days in the early group, 34.7 days in the delayed group and 31.5 days in the late group. There were no flap failures. In our experience the duration of surgery was significantly lower in the delayed group compared to the late group. However, the duration of hospital stay was comparable. Tissue transfer for the coverage of trauma-related soft tissue defects offers an effective option/solution to a difficult situation often faced by the surgeon. Early reconstruction reduces the complexity of surgery, the patient morbidity and enhances the success of treatment. Lymphoma is a malignancy caused by clonal proliferation of lymphoid cells. Non-Hodgkin’s lymphoma (NHL) is mostly derived from clonal proliferation of B lineage cell. The use of PCR technique in detection of IgH chain gene rearragement and specific moAb in flow cytometry analysis enable clonal population of lymphoid cells involved in malignant tumour be detected. Thus, reactive and malignant condition could be differentiated. Objective: To detect clonal lymphoid population using IgH chain gene rearrangement and flow cytometry analysis in NHL. Single cell suspensions were prepared from 30 fresh lymph node (LN) excised from patients suspected of having lymphoma. Cells were reacted with moAb and analysed by FACScan. Another part of the LN were frozen and DNA was extracted using standard method. DNA was subjected to PCR using specific primers for IgH chain gene rearrangement (VH/JH). Another LN from the same patient was fixed in formalin and subjected to immunohistopathology examination in normal way. By morphologic and cell surface criteria (HPE and IHC), 15 cases were diagnosed as NHL-B, 1 case of NHL-T, 4 cases of Hodgkin’s Disease, 6 cases of reactive hyperplasia, 2 cases of metastatic carcinoma and 2 cases of tuberculosis. Flow cytometry analysis showed positivity for B lymphoid cell population in 10 out of 15 NHL-B cases while 5 showed positivity in T lymphoid cell population. All other cases, including NHL-T showed positivity in T lymphoid cell population, Using IgH chain gene rearrangement, all 15 cases of NHL-B and a case of NHL-T produced a specific band at 100–180bp while 2 cases of Hodgkin’s Disease and metastatic carcinoma produced nonspecific band at 100–180bp and 400bp. No band was observed in reactive hyperplasia and tuberculosis. IgH chain gene rearrangement could serve as a specific technique in detecting clonal population especially in B-lineage NHL. Flow cytometry analysis can provide rapid confirmation of lineage and clonality of B-lineage NHL when more than 50% of B-cell surface markers are positive and when definite Ig light chain restriction is present. Thus, IgH chain gene rearrengement and flow cytometry analysis could be a useful adjunct to immunohistochemistry in detection of lineage and clonality in NHL. Laryngoscopy and tracheal intubation are known to increase sympathetic activity that may be detrimental to patients with preexisting heart disease. Objective: To compare the effect of combining fentanyl and esmolol with that of either agent alone in obtunding hyperdynamic response to intubation. Sixty ASA physical status class I or II patients were enrolled in this randomized, double blind study and divided into three groups. Group 1 (n = 20) received combination i.v. fentanyl 2 ug/kg and i.v. esmolol 2 mg/kg, group 2 (n = 20) received i. v. fentanyl 4 ug/kg and group 3 (n = 20) received i.v. esmolol 3 mg/kg at the start of anaesthetic induction. Patients were then given i. v. thiopentone 4 mg/kg and i. v. succinylcholine 1 mg/kg and ventilated with 100% oxygen for 1 minute. Intubation was then performed and anaesthesia was maintained with 1% isoflurane, Nitrous Oxide in 50% Oxygen and i.v. tracrium 0.5 mg/kg. The blood pressure, heart rate and oxygen saturation were obtained at one-minute interval from the start of induction and continued up to 10 minutes post intubation. There was no difference in the demographic data among the three groups (p>0.05). Following tracheal intubation, the maximum percentage change of systolic BP from baseline was significantly less in the group 1 (0.06%, p = 0.986) and group 2 (0.02%, p = 0.995) as compared to group 3 (21%, p = 0.004). The maximum percentage changes of heart rate from baseline was less in the group 1 (6.6%, P = 0.119) than in group 2 (15%, p = 0.001) or group 3 (25.5%, p = 0.000). Combined low dose fentanyl and esmolol is most effective as compared to higher doses of either drug alone in obtunding hyperdynamic response to laryngoscopy and tracheal intubation. b3-adrenergic receptor (b3-ADR) is a G protein-linked receptor that is expressed in visceral adipose tissue and is thought to be a regulator of lipolysis and thermogenesis. Its gene is located on chromosome 8p11-p12. Recent studies have shown a possible pathogenic mutation of Tryptophan 64 Arginine in the b3-ADR gene which is associated with an earlier onset of non-insulin dependent diabetes mellitus (NIDDM) and clinical features of insulin resistance syndrome in Caucasian subjects. In our study, we aim to investigate this similar polymorphism in patients clinically diagnosed as NIDDM in Kelantan Malay subjects. DNA was extracted from whole blood and Trp 64Arg polymorphism was detected using restriction enzyme (MvaI) in 19 patients with NIDDM ( 7 men & 12 women, age 55.3 ± 9.80, BMI 25.5 ± 3.46, BP 131.6 ± 22.67 / 82.1 ± 9.76. 10 control samples were from subject without NIDDM ( 4 men and 6 women, age 36.3 ± 7.51, BMI 25.1 ± 3.13, BP 120 ± 6.67 / 80.0 ± 6.67 ). We have found 4 heterozygous Tryptophan/Arginine (Trp64Arg) and 15 homozygous Tryptophan (Trp64Trp) in patient samples. No homozygous Arginine (Arg64Arg) was detected. Whereas there were 2 homozygous Arginine (Arg64Arg), one heterozygous Tryptophan/Arginine (Trp64Arg) and 7 homozygous Tryptophan (Trp64Trp) found in control samples. The total polymorphism occurred in patient samples were 4 as compared to 3 polymorphism occurred in control samples. In this preliminary report, the total allele frequencies of the 64Arg mutation of the b3-ADR gene was similar in patient and with in control samples ( 15.4 & 30.0 respectively). Our study will be continued with higher number of samples to confirm the association between Trp64Arg polymorphism of the b3-ADR gene with NIDDM in Kelantan Malay population. This Trp64Arg polymorphism of the b3-ADR gene study may also contribute to the future obesity and hypertensive studies. This paper reports on anthropometric data and dietary intake of children between the ages of 6 and 72 months in Baling, Kedah. The findings reported here are part of the bigger study on the relationships between family dynamics, lifestyles and nutritional status of children. This study is part of the Healthy Lifestyle IRPA Top-Down Project funded by the Ministry of Science, Technology and Environment Malaysia. The objective of the study was to compare the dietary intake of the malnourished and non-malnourished children between the ages of 6–72 months old. A subsample of 40 children were randomly selected from the total number of 199 children obtained for the bigger study A three-day diet records through home-stay observation were recorded.. The mothers were interviewed using a set of questionnaire developed for the study. The nutrients intake of the children was measured using a typical 24- hour dietary recall. The data were collected April 1998 to June 1999. The weight and height of children aged 6–24 months were measured with Tanita pediatric balance and Infantometer respectively. Children aged 25–72 months were weighed using Tanita digital balance and microtoise tape. Data was analyzed using the SPSS version 9.0. Anthro.1 was used to analyze antropometric assessment and Nutrical version 1.02 was used to analyze dietary intake. The dietary intake of the children was compared using a t-test. The result of the anthropometric assessment of the 40 children showed that 47.5% of the children was below −2SD of weight for age. The z score below −2SD and below, was classified as malnourished and the z score of −1.99SD and above was classified as non- malnourished. The mean intake of selected nutrient of the children were 878 calories for energy, 37.7g for protein, 23.3g for fats, 336.4mcg for vitamin A, 315 mg for calcium, 9.5 mg for ferum and 30.8mg for vitamin C. The intake of vitamin A and calcium were significantly higher (p<0.05) for the nonmalnourish groups. The mean intake of vitamin A for the malnourished group was 250.8 mg/day and 414 mcg for the non-malnourished group respectively. The calcium intake was 210 mg for the malnourished group while for the nonmalnourished was 409 mg per day. There was also a significant difference (p<0.05) on the intake of fat between the two groups. This study demonstrated that nutrient intake is a significant cause of malnutrition among children 6–72 months. Vitamin A and calcium intake seen to be deficient in the diet of the malnourished children. A detailed intervention study was planned for the malnourished with emphasis on the nutrients found deficient in the study. Dentine is a biological mineralized tooth structure that is densely perforated with tubules that extend from the pulp chamber to the enamel-dentine junction. These dentinal tubules is an attributing factor to dentine permeability (Thomas, 1985). VPSEM allows inquisitive recognition of the tissue morphological characteristics in their natural hydrated state. No prior critical-drying or coating is needed. In conventional high vacuum SEM, specimens need to be coated with conductive material like gold to dissipate charge build up. It is hoped that insights gained from this study will further update knowledge of use to oral biology especially to the understanding of dentine sensitivity. The study gives an anatomical overview of the morphology of partially demineralised molar human tooth preparations with special emphasis to its tubules diameter and numbers located at the middle part of the coronal end pulp chamber using a LEO 1455VP VPSEM without the tedious conventional scanning electron microscope tissue preparation protocols. Five caries free adult human molar tooth were chemically fixed in 10% formalin immediately after extraction for 24 hours, than demineralised in 10% EDTA at pH 7.3 for 4 weeks, with regular changes of the demineralization solution. On the 4th week enamel were macroscopically absent leaving occlusal dentine exposed. The partially demineralised dentine was divided into two halves using a scalpel; then rinsed with repeated changes of ringer’s solution. Each halves was examined under the VPSEM, using its peltier cooling sub-stage at 35 Pascal pressures at an accelerating voltage of 15 kV. They were examined from occlusal to the pulpal border. Photomicrographs images of the tubules were transferred to Leica imaging workstation to enable accurate study analysis. Grey image processing was used to extract dentinal tubules. Binary image processing was used to remove artifacts. Resultant image was measured and colour-coded in accordance to histogram classes. Statistical results for area, length, breadth, perimeter and equivalent diameter were tabulated Demineralised dentine undergoes morphological shrinkage during normal dehydration post-demineralization and thus provides a false value of its tubule density and diameter (Garberoglio & Brannstrom 1976). In our partially demineralised dentine preparations the tubules appeared intact and were mostly empty. Summary statistics showed that mean and standard deviation were: area 4.88 ± 2.43, length 3.22 ± 0.94, breadth 2.08 ± 0.58, perimeter 9.93 ± 3.22, and equivalent diameter 2.41 ± 0.62 which indicates normally distributed data. Childhood and adolescent poisonings contributed significantly to injury-related morbidity, mortality and economic burden. This study assesses the trends in children and adolescent poisoning and related costs. Both retrospective and prospective approaches were adopted. Retrospective data of poisoning cases involving patients less than 21 years old presented to University Malaya Medical Centre (UMMC) over an eight-month period were collected, followed by a prospective study conducted over a one-month period. About 16±4.2 cases of poisoning occurs per month. The study reveals that poisonings alone accounted for almost RM 10000 of monthly hospitalisation costs for children and adolescents. Between RM60 to RM4000 was incurred per patient with a length of stay between 1 to 10 days. Pharmaceuticals appeared to be most common agent used. Adolescents aged of 18 to 21 contributed to the majority (51.5%) of poisoning cases. Further research are needed to determine whether cost reductions through more effective management could be achieve improve the clinical outcomes in children and adolescent poisoning in UMMC. The risk and incidence of post-operative pulmonary complications (PPC) differ greatly according to type of surgery performed. The complication rate with respect to both morbidity and mortality is greater for upper than lower abdominal procedures (Brun 1997, Hall 1991). There is a marked reduction in vital capacity of up to 60% of the pre-operative value (Tisi 179) in the upper abdominal operation and together with reduction in FRC post-operatively predispose patient to PPC. We prospectively studied, post-laparotomy patients, performed in Hospital USM between January 1994 and December 1998 ( 40 months), and aimed to determine the incidence of PPC and their relation to the surgery performed. We looked into three parameters namely the: (A) site of incision, (B) direction of incision and (C) length of incision. Site of incision: 1a. Surgery involving oesophagus, gastroduodenum, hepatobiliary, pancreas and spleen is considered as upper abdominal surgery; 1b. Surgery involving small bowel, colorectal and appendix is considered as lower abdominal surgery. Direction of incision is divided into (a) vertical and (b) horizontal Length of incision: (a) 15 cm. A total of 318 patients were included in the study ( 187 males and 131 females, mean age: 43.9± 19 years). 230 patients had no PPC while 88 patients developed PPC following laparotomy. 38 of 128 patients with upper abdominal surgery and 50 of 190 with lower abdominal surgery developed PPC ( p= 0.509, OR=1.18 ). 65 of 179 patients with vertical incision; and 23 of 139 patients with longitudinal incision developed PPC (p= 0.000, OR= 2.88). 7 of 79 patients with incision less than 10 cm; 54 of 147 patients with incision between 10 to 15 cm and 54 of 147 patients with incision more than 15 cm developed PPC (p= 0.000, OR=2.34). There is a significant risk of developing PPC associated with the site of surgical laprotomy incision (determined with the organ involved); direction of the incision made, as well as the length of the incision itself