The prevalence of asthma in Victorian adults. To determine the prevalence of asthma in Victorian adults, we carried out a cross-sectional postal survey utilising a new screening questionnaire which gathered data on self reported respiratory symptoms, whether asthma had been diagnosed and, if so, how it had been treated. Questionnaires were returned by 2198 (72%) of 3095 adults selected randomly from the Victorian electoral roll, an adequate response rate. The reported prevalences of individual asthmatic symptoms in the last 12 months ranged from 8% for nocturnal wheeze to 22% for current wheeze. Thirteen per cent of respondents had ever had asthma, 7% had experienced an attack within the last 12 months and 6% were currently taking medication. The high prevalence of asthma revealed by our study has major implications for the planning of health services.


Reoperation for recurrent coronary artery disease--a ten year experience. The need for reoperation caused by recurrence of coronary artery disease is becoming increasingly common. Although reoperation is more difficult and time-consuming, with careful surgical technique it can be carried out with the same mortality as that described by many units for primary coronary artery bypass grafting (1.2-2.0%). In the 172 patients described here, who had coronary artery reoperations between 1981 and 1990, there were two in-hospital deaths (1.2%). There were three postoperative bleeds which required return to theatre. No patient suffered a postoperative neurological deficit or postoperative myocardial infarction. These reoperations comprised 6.9% of the 2497 coronary artery operations carried out in the same period. Follow-up disclosed eight late deaths, from five-62 months after operation; all survivors claim to be symptomatically improved. Consideration should be given to the potential problems of reoperation when carrying out primary myocardial revascularisation.


A mucosal barrier of gastric surfactant identified in the human stomach. Using a special fixation procedure avoiding glutaraldehyde, an oligolamellar lining has been demonstrated by electronmicroscopy on the luminal surface of the human stomach and, with more lamellations, on the epithelial surfaces of oxyntic ducts and parietal cells. These results indicate that, in the human stomach, there is indeed a gastric mucosal barrier consisting of a multi-laminated structure of surface-active phospholipid (SAPL). This gastric surfactant is probably produced in parietal cells and surface mucus cells in which lamellar bodies and some prominent multi-focal lamellated agglomerates of SAPL were prevalent. These findings of a gastric mucosal barrier similar in structure and function to a very thin polyethylene liner are compatible with previous information about the hydrophobicity of the gastric mucosa, the clinical correlation of hydrophobicity with peptic ulceration and the action of barrier breakers (including Helicobacter pylori). It is speculated that the administration of exogenous gastric surfactant in various forms may be effective for inexpensive long-term maintenance of the ulcer patient treated acutely by more conventional means.


All-trans retinoic acid in the treatment of acute promyelocytic leukaemia. All-trans-retinoic acid (ATRA) is known to induce differentiation of promyelocytes in vitro and also to induce remission of acute promyelocytic leukaemia in vivo. We treated 11 patients with poor prognosis acute promyelocytic leukaemia (APL) with ATRA and obtained seven complete and one partial remission. Remissions took one to three months to achieve and were associated with adverse effects including dry skin and bone pain. In eight patients the white cell count rose above 20 x 10(9)/L within the first ten days of retinoic acid treatment and this was associated with the development of pulmonary leukostasis in three patients which was fatal in one. Another two patients died of intracranial haemorrhage also within the first ten days. ATRA is a promising new agent in the induction therapy of this particular category of acute leukaemia.


Neuroendocrine protein 7B2 in Prader-Willi syndrome. 7B2 is a neuroendocrine polypeptide of unknown function, the gene for which is sited near or within the chromosomal region deleted in Prader-Willi syndrome and Angelman's syndrome. Plasma immunoreactive 7B2 levels were measured in 26 individuals with Prader-Willi syndrome, and appropriate controls. Plasma 7B2 levels were within normal limits compared to the control groups, in adults with Prader-Willi syndrome. 7B2 levels in children with Prader-Willi syndrome were higher, this age-dependent variation having been previously reported in normal children.


Phrenic nerve pacing in two young quadriplegic ventilator-dependent patients. Patients who survive high cervical injury are usually dependent on mechanical ventilation and tracheostomy if the lesion above C3 is complete. We report our experience with phrenic nerve pacing (PNP) to achieve ventilator-independence in two young quadriplegic patients. A diaphragm conditioning programme, and combination of low frequency electrophrenic stimulation within each inspiratory burst and low breathing frequency enabled both patients initially to achieve continuous 24 hour ventilation independent of mechanical ventilation. One patient reverted to overnight mechanical ventilation (six hours) after three years. PNP should be considered in ventilator dependent patients with high cervical injury to achieve independence and improve quality of life.


Substantia nigra degeneration in motor neurone disease: a quantitative study. There is increasing evidence of degeneration of nerve cells other than motor neurones in sporadic motor neurone disease (MND). Sporadic MND is occasionally associated with Parkinsonism. The aim of this study was to determine whether neuronal loss occurs in the substantia nigra of MND patients. Case records and pathological material from 14 patients with MND were reviewed. No patient had Parkinsonism documented. Sections of substantia nigra from the patients and 14 age/sex matched controls were analysed by neuronal and macrophage quantitation. The mean number of pigmented neurones at one standard level of substantia nigra was 863 in cases and 1094 in controls (p < 0.02); on average 21% (95% CI, 7-35%) fewer in the cases. The mean number of macrophages containing neuromelanin in cases was 106 and in controls 45 (p < 0.02). The results indicate that patients with MND have degeneration of the substantia nigra. Thus MND should be considered as a type of multiple system atrophy in which the motor neurone bears the brunt of the disease. The implication of this to the relationship between classical MND and MND with Parkinsonism-Dementia of the Western Pacific is discussed.


Streptococcus pneumoniae: how common is penicillin resistance in Australia? Streptococcus pneumoniae in the past were uniformly susceptible to penicillin. Increasing levels of resistance are now seen worldwide. To define the prevalence of this resistance in Australia, a collaborative study was carried out on all pneumococcal isolates at 15 large metropolitan teaching hospitals. During 1989 details of results of penicillin testing using routine methods were recorded. Isolates found resistant to penicillin were forwarded to Woden Valley Hospital for determination of penicillin minimum inhibitory concentration (MIC). All invasive isolates from five of these hospitals were also forwarded during 1989 and 1990 for MIC testing. Of the 1822 isolates tested, 31 (1.7%) were recorded as penicillin resistant. However, only 16 of 22 resistant isolates forwarded for MIC testing had MICs of > or = 0.1 mg/L confirmed. After adjustment to account for discrepancies with different laboratory testing methods we calculated the likely penicillin resistance to be 1% of isolates. Two of 105 invasive strains tested were found to be penicillin resistant. We conclude that penicillin-resistant S. pneumoniae isolates, including isolates from invasive sites, are found in Australia. All of these isolates had an MIC between 0.1 and 1 mg/L and are thus regarded as 'intermediately' penicillin resistant isolates. No high level resistance (MIC > or = 2 mg/L) was observed. Ongoing surveillance is essential to detect changes in resistance patterns and prevalence, as this will have implications for the empiric treatment of serious disease caused by S. pneumoniae.


A survey of interhospital transfer of head-injured patients with inadequately treated life-threatening extracranial injuries. A 12 month prospective study was undertaken to determine the frequency of untreated life-threatening extracranial injuries in patients transferred to a major trauma centre because of head injury. Of the 43 patients transferred (15 with isolated head injury and 28 with multiple injuries), four (9%) had an untreated life-threatening extracranial injury, which caused death in two. All four patients with untreated extracranial injuries were transferred from hospitals with general surgical staff and facilities. In three of the patients (none with a major head injury), the extracranial injuries were recognized at the referring hospital, but were left untreated in the rush to transfer the patient to a neurosurgical facility. In the fourth patient, who had a severe head injury, recurrent hypotension from a ruptured spleen was mistakenly ascribed to a scalp wound. The series shows that the dangerous practice of hurriedly transferring patients to trauma centres because of actual or perceived head injuries, while leaving major extracranial injuries untreated, continues despite warnings in the literature and the efforts of the Royal Australasian College of Surgeons through the Early Management of Severe Trauma programme.


Controversies in the management of brainstem cavernous angioma: report of two cases. Two cases of cavernous angioma involving the medulla oblongata are presented. Both cases underwent surgical excision with excellent outcome. The use of surgery via craniectomy is contrasted with stereotactic radiosurgery in light of the known natural history of the lesions. As a result, it is suggested that surgical excision provides immediate protection from the risks of recurrent haemorrhage, establishes a tissue diagnosis, allows complete removal at the primary intervention, avoids complications of radiation-induced damage and is performed more easily in these vascular anomalies due to the presence of a capsule with surrounding gliotic tissue. Additionally, it is implied that the natural history of lesions in this region is still unclear. For these reasons, it is suggested that surgical excision should be the primary therapeutic intervention for cavernous angiomata that involve the brainstem.


Pars interarticularis stress and disc degeneration in cricket's potent strike force: the fast bowler. Cricket fast bowlers are the potent strike force in a multidiscipline team. They subject their spines to repetitive sagittal plane and rotatory movements over many years. The effect of this repetitive stress has not previously been analysed. This study examined 20 former fast bowlers to determine the incidence of spondylolysis, spondylolisthesis and degenerative change. Fast bowlers are noted to have an increased incidence of spondylolysis. A mixed front/side bowling style involving more lumbar hyperextension or rotation has significant association with spondylolysis when compared with side-on bowling styles. There was a high incidence of radiological thoracolumbar degenerative facet joint and disc disease in former fast bowlers.


Rehabilitation of lower limb amputees and some implications for surgical management. Aspects of peri-operative management, amputation level and rehabilitation of the lower limb amputee are reported in the context of a review of a rehabilitation service for amputees which includes an integrated prosthetic service. Two hundred admissions were reviewed and some complex cases described. It is concluded that: a very close liaison between the surgeon and the rehabilitation team (ideally with preoperative consultation) is in the patient's best interests; any person previously walking (or a potential walker) should be considered for a trial of prosthetic walking; an integrated prosthetic service enhances the efficiency of the rehabilitation service; and that modification of the current Artificial Limb Scheme to allow manufacture of first definitive limbs in prosthetic rehabilitation units would further enhance service to patients.


Splenic abscess.

Splenic abscess. Isolated splenic abscess is an uncommon condition. Seven cases seen between 1980 and 1990 are reviewed. The clinical presentation is non-specific and diagnosis is usually delayed. Computerized tomography allowed for accurate diagnosis in all cases. Pseudomonas species as a causative organism is reported to be rare, but were present in three of the present cases. Antibiotic therapy alone is insufficient and splenectomy remains the treatment of choice.


Corporeal penile plication for correction of erectile penile deformity. Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow-up was 16 months (range 3-48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.


Perineal proctectomy for rectal prolapse in elderly and debilitated patients. This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff. There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow-up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re-operated for recurrent symptomatic prolapses at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse. Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.


Hurthle cell neoplasms of the thyroid gland revisited. Hurthle cell tumours (benign and malignant) have been regarded as lesions with uncertain biological behaviour. However recent clinico-pathological studies have shown that they should be categorized as benign or malignant on the basis of capsular and/or vascular invasion, like other differentiated thyroid neoplasms. The fact that the tumours are composed of Hurthle cells is irrelevant. Currently, histological parameters do not seem to predict biological behaviour of Hurthle cell carcinomas.


The transanal resectoscope: an under-used instrument? The use of the urological resectoscope in the treatment of rectal tumours has been described in detail. We report the use of the purpose built transanal resectoscope in the treatment of 34 patients. Fourteen patients had villous adenomas and all but one were relieved of symptoms. Of 20 patients with rectal carcinoma, three presented with acute intestinal obstruction and three had rectal stump recurrences. Palliation was excellent in patients with general symptoms, but the results were disappointing for rectal stump recurrences. Transanal resection (TAR) is a novel form of treatment for patients with rectal obstruction. Two patients in this study had their obstruction successfully relieved by transanal resection alone. This allowed formal bowel preparation and full pre-operative assessment. We feel that this technique is under-used and that the results of treatment justify more widespread acceptance of the procedure.


A case of primary mesenteric fibromatosis. A case of primary mesenteric fibromatosis is reported and the current modalities of therapy are discussed. Surgery is the primary mode of treatment. Other modalities should be reserved for gross local residual disease and for unresectable recurrence.


Dieulafoy's ulcer: a palpable entity?

Dieulafoy's ulcer: a palpable entity? Two cases of Dieulafoy's ulcer are reported. Diagnosis was delayed but successful surgical treatment was achieved once the lesion was located by palpation.


Delayed cerebrospinal fluid rhinorrhoea: a case report. Post-traumatic cerebrospinal fluid (CSF) rhinorrhoea is a well recognized complication of closed head injury. Most cases occur soon after injury and a delay in presentation of more than 1 month is unusual. A case is reported of CSF rhinorrhoea presenting 15 years after initial trauma which was complicated by meningitis after 12 months. The management of this condition is reviewed.


Central venous thrombophlebitis diagnosed by computerized tomography scanning. A case is described in which computerized tomography scanning aided in a prompt diagnosis and assessment of an intravenous catheter-induced septic thrombus. Computerized tomography scanning detected gas bubbles within the thrombus, which extended from the right subclavian vein into the superior vena cava, and retrograde propagation of the thrombus into the right internal jugular vein. Computerized tomography scanning also helped in the assessment of the amount of deep tissue swelling present and the competence of the upper respiratory tract.


Spontaneous knotting of a pigtail ureteric stent in the ureter requiring percutaneous removal. Insertion of a ureteric stent is a common procedure in urologic practice. Ureteric stenting may be performed for: ureteric obstruction, benign or malignant: to prevent ureteric obstruction from stone fragments after extracorporeal shockwave lithotripsy (ESWL); or to prevent leakage from the upper urinary tract. A case of spontaneous knotting of a ureteric stent in situ is reported. Although this complication has been reported previously it is rare.


Ovine nasal zygomycosis caused by Conidiobolus incongruus. About 700 sheep died on 52 farms in north-western New South Wales and south-western Queensland over a 3 mo period. Affected animals had a marked asymmetrical swelling of the face, extending from the nostril to just anterior to the eyes. They lost condition rapidly and died within 7 to 10 days. At necropsy there was a unilateral severe necrogranulomatous rhinitis with extension of inflammation into the adjacent subcutaneous tissue, nasal septum and hard palate. Metastatic lesions were present in the draining lymph nodes and in the thorax. Histological changes consisted of a granulomatous reaction with numerous eosinophilic foci of necrosis and a diffuse, heavy, mixed inflammatory cell response. Many vessels had segmental necrosis and thrombosis. Fungal hyphae were numerous, particularly within or associated with necrotic foci. Conidiobolus incongruus was isolated from nasal tissues, parotid and submandibular lymph nodes and pulmonary lesions.


A comparison of the pathogenicity of two strains of hog cholera virus. 1. Clinical and pathological studies. The virulence of a strain of hog cholera virus isolated during an outbreak of mild disease in pigs in New South Wales in 1960/61 (the NSW strain) was compared over 11 days with that of a virulent strain by inoculating 8 pigs with each virus and comparing the ensuing clinical signs and pathology. Both viruses caused persistent pyrexia and leukopenia, the NSW strain 4 to 5 days and the virulent strain 3 days, after inoculation. Few other clinical signs were observed in the pigs inoculated with the NSW strain. In contrast, all pigs inoculated with the virulent strain became progressively depressed and incoordinated, and were killed between days 6 and 9. Bronchopneumonia and swollen, reddened lymph nodes were observed in pigs inoculated with both viruses. Few other gross lesions were observed with the NSW strain, but some pigs receiving the virulent strain had pustules in the tonsil and the anterior oesophagus, petechial haemorrhages in the kidney, and small infarcts at the margins of the spleen. There were marked differences in the histopathology, both in the variety of organs affected and the severity of lesions in individual organs. Suppurative bronchopneumonia occurred in both groups. Other changes in the pigs affected with the NSW strain were colitis, mild cerebral vasculitis, necrosis, haemorrhage and neutrophil infiltration in some lymph nodes and spleens. In pigs infected with virulent virus the cerebral vasculitis was so severe that there was necrosis of cells within the vessel walls.(ABSTRACT TRUNCATED AT 250 WORDS)


A comparison of the pathogenicity of two strains of hog cholera virus. 2. Virological studies. Quantitative and qualitative differences were demonstrated in the amount of virus in a range of tissues from pigs infected with either the Weybridge or New South Wales (NSW) strains of hog cholera (HC) virus. The titre of the Weybridge strain in samples, as assessed by either virus titration in cell culture or by the density of specific fluorescing cells in tissue sections, was higher than that for the NSW strain. This correlated with the greater severity of the clinico-pathological syndrome induced by the Weybridge strain. The implications of the differences in the virus content of tissues in the diagnosis of HC is discussed as is the use of monoclonal antibodies to differentiate HC and bovine virus diarrhoea viruses.


Evaluation of an enzyme-linked immunosorbent assay for the detection of Mycoplasma hyopneumoniae antibody in porcine serum. An enzyme-linked immunosorbent assay (ELISA) for detecting antibody to Mycoplasma hyopneumoniae in porcine serum is described. The results are presented as an ELISA ratio, calculated by dividing the absorbance of the test sample by the mean absorbance of control negative sera. In known infected pigs, the ELISA ratio was highest when the serum concentration applied to the ELISA plate was diluted 1 in 20 in PBS - Tween. Mean ELISA ratios ranged from 1.2 +/- 0.3 for pigs without porcine enzootic pneumonia (PEP) lesions to 5.5 +/- 1.5 for pigs observed with a PEP lesion reacting positively with immunofluorescent histopathology. Pigs observed with typical PEP lesions at slaughter, but not confirmed by immunofluorescent histopathology had a mean ELISA ratio of 4.9 +/- 1.7. The ELISA was highly sensitive (95.6%) and specific (98.8%) when pig sera from commercial piggeries of known M hyopneumoniae infection status were assessed. No cross-reactivity with serum from a pig hyperimmunised with killed M flocculare was detected, and reactivity with serum from another pig hyperimmunised with killed M hyorhinis showed only weak cross-reactivity, which failed to reach the ELISA positive threshold (ELISA ratio 3) for M hyopneumoniae.


Management of land and livestock contaminated with polychlorinated biphenyls. Investigations were conducted on several small neighbouring beef cattle and sheep farms that were found to be contaminated with polychlorinated biphenyls (PCBs). The residues detected contained about 62% w/w chlorine and soil concentrations ranged from 0.35 to 1.9 mg/kg. Beef cattle and sheep grazing the contaminated land had PCB concentrations in their fat of 0.3 to 1.7 mg/kg and 0.19 to 0.45 mg/kg, respectively. The concentration of PCBs in the caudal fat of cattle was 0.3 to 2 times the concentration of PCBs in the land they were grazing and was positively related to stocking rates. PCBs were present in milk fat from cattle at about the same concentration as in caudal fat, and lactation appeared to contribute to decontamination. Wool grease from sheep contained about 1 to 2 times the concentration of PCBs in subcutaneous fat. Calves of contaminated cows also became contaminated. The half-life for decontamination of PCBs in a group of 8 young female beef cattle was calculated at 13 months. PCBs were detected in pasture samples at concentrations ranging from less than 0.01 mg/kg to 0.12 mg/kg. However, PCBs were not detected in any sample of hay cut from these paddocks. In 4 sheep fed a sole ration of this hay, traces of PCBs were detected in their fat following 89 days of feeding. Grazing livestock for meat production on land contaminated with PCBs is not recommended because livestock readily acquire residues, and PCBs persist in soil and livestock for long periods. Grazing sheep for wool production on land contaminated with PCBs may be an option.


Failure of a single postpartum prostaglandin treatment to improve the reproductive performance of dairy cows. A study was conducted to evaluate the effects of postpartum prostaglandin treatment on reproduction in 3 seasonal calving dairy herds. Recently calved lactating dairy cows were paired on herd, age, calving date and previous production index. One cow in each of the 196 pairs received a single intramuscular injection of 25 mg of the prostaglandin analogue, dinoprost, between 14 and 28 days after calving. Subsequent reproduction was monitored. Within each herd and overall, there was no significant effect of treatment on the intervals from calving to first service, mating start date to first service, calving to conception, mating start date to conception and first service to conception. Treatment also had no significant effect on 21-day submission and pregnancy rates, on the proportion of each group not pregnant at the end of mating, and on first service pregnancy rates. Responses to treatment did not vary between cows calving within 50 days of mating start date and earlier calving cows or between cows aged less than 5 years and older cows.


Salivary and plasma cortisol as an index of stress in goats. Total assayable cortisol in plasma was highly correlated (r = 0.97) with physiologically active free cortisol in plasma after routine management procedures in 1- to 3-weeks-old goats. Transport of adult goats caused significant increases (P less than 0.001) in free cortisol in saliva and in free and total cortisol in plasma. No difference (P greater than 0.05) between concentrations of free cortisol in saliva and in plasma was apparent before or after transport. The results demonstrated that the salivary cortisol method is a useful measure of stress in adult goats, and that the relationship between free and total cortisol in plasma, and the adrenocortical response to transport, appear to be similar in sheep and goats.


Locomotor effects in sheep of alkaloids identified in Australian Tribulus terrestris. Fresh, mature, ungrazed Tribulus terrestris plant material was subjected to a standard alkaloid extraction procedure. The extract was fractionated by thin layer chromatography (TLC) and high performance liquid chromatography (HPLC). Two major alkaloid fractions were demonstrated. These fractions were identified by means of TLC, ultraviolet spectrofluorimetry (UVS) and HPLC, as the beta-carboline indoleamines harmane and norharmane. The extractable alkaloid content was determined to be 44 mg/kg dry matter. Synthetic harmane and norharmane were administered subcutaneously to sheep at a dose rate of 54 mg/kg. Both compounds caused similar nervous effects. The main effect observed was limb paresis, which in some sheep was body side blased. The clinical signs observed in the experimental sheep were consistent with those described for naturally occurring cases of Tribulus terrestris staggers. It was proposed that harmane and norharmane accumulate in tryptamine-associated neurones of the central nervous system, during months of tribulus ingestion, and gradually interact irreversibly with a specific neuronal gene DNA sequence.


Mechanisms underlying Phalaris aquatica "sudden death" syndrome in sheep. Twenty outbreaks of Phalaris aquatica "sudden death" syndrome in sheep were investigated between 1981 and 1991. Four were confirmed and one was suspected, to be a cardiac disorder; 5 were confirmed and 3 were suspected, to be a polioencephalomalacic disorder; the aetiology of the remaining 7 outbreaks could not be determined. Potentially toxic levels of hydrocyanic acid (20 to 36 mg/100 g) were measured in the 3 toxic phalaris pastures tested. The measurement of potentially toxic levels of nitrate nitrogen (2920 micrograms/g) in toxic phalaris pastures by others, was noted. It is suggested that phalaris "sudden death" syndrome could have as many as 4 different underlying mechanisms, and that these might reflect the presence in the plant of a cardio-respiratory toxin, a thiaminase and amine co-substate, cyanogenic compounds, and nitrate compounds.


Occupational contact dermatitis in New South Wales. Five hundred and seventy patients with occupational contact dermatitis (OCD) were seen between 1984 and 1990 at the Skin and Cancer Foundation in Sydney. Data derived from these patients demonstrated that hairdressing, food, construction and the medical industries were the most at risk of OCD. The hairdressing and food industries had a high percentage of apprentices suffering OCD whilst the 35 to 44 year age bracket was most at risk in the construction industry. Allergic contact dermatitis was responsible for 38.2% of cases. The main allergens were chromate, thiuram, epoxy resin, nickel and cobalt. A third (33.9%) of patients were atopic. The average time lost from work was 16 days each year and the calculated yearly cost of OCD in New South Wales was approximately $12 million.


Skin reactions to diltiazem.

Skin reactions to diltiazem. A survey of Australian dermatologists was conducted into skin reactions observed to diltiazem. These have included: erythema multiforme, subcorneal pustular dermatosis, photosensitive erythroderma, macular exanthem, allergic vasculitis and urticarial vasculitis. The range of clinical and histopathological features are described. A review of the literature is presented. Photosensitive erythroderma and urticarial vasculitis have not, to our knowledge, been reported in the literature previously.


Keratoderma hereditaria mutilans. Etretinate treatment and electron microscope studies. Keratoderma hereditaria mutilans is a rare inherited cornification disorder characterized by hyperkeratosis of palms and soles with a characteristic "honey-comb" appearance, keratotic constriction furrows of one or more digits (pseudo-ainhum) and threatening spontaneous amputation. Approximately 30 cases have been reported, but the ultrastructural features have not been well characterized. In this article, we describe the clinical, histologic, and ultrastructural findings in our patient. A biopsy specimen taken before treatment with etretinate showed hyperkeratosis with a well-preserved granular layer and acanthosis. Ultrastructural examination disclosed that the spinous cells and granular cells contained marked swollen mitochondria, many desmosomes, and that corneocytes contained many membrane coating granules (MCG) and lipid like vacuoles. After initiation of treatment, considerable clinical improvement was observed, but without significant histologic modification. The principal post-treatment ultrastructural changes were the reduction of mitochondrial swelling in spinous and granular cells and the reduction in the number of MCG in corneocytes. The intercellular spaces showed increased amounts of fine and coarse granular substances. Stimulation of Langerhans cells was observed. Marginal band formation occurred normally after treatment.


Familial non-diabetic necrobiosis lipoidica. Necrobiosis lipoidica (NL) is a cutaneous disorder with distinctive clinical and morphologic characteristics. It is associated with diabetes mellitus in two thirds of cases. The aetiology and pathogenesis of NL are unknown but familial cases of NL seem to be extremely rare. We report the occurrence of NL in two sisters with normal glucose tolerance.


Hormonally exacerbated hereditary angioedema. Hereditary angioedema is a rare disorder which is associated with an inherited deficiency of the inhibitor of the activated first component of complement. Genetic transmission occurs in an autosomal dominant manner. Affected patients are heterozygotes, and their deficiency is incomplete, many of them having up to 20% of the normal amount of the inhibitor. We describe two cases of C1 esterase inhibitor deficiency occurring in a mother and daughter in whom the symptoms appeared to be related to the menstrual cycle or the taking of the oral contraceptive pill. Although both features have been mentioned in the literature, to the best of our knowledge premenstrual exacerbations have not been documented previously. We examined the likely basis of hormonally exacerbated hereditary angioedema.


Pilomatrix carcinoma of the scalp.

Pilomatrix carcinoma of the scalp. A matrical carcinoma (pilomatrix carcinoma) of the scalp is described--the first reported case in this site. This malignant hair follicle tumour must be distinguished histologically from benign pilomatricoma and proliferating trichilemmal tumour, which can have similar features.


Infantile pyoderma gangrenosum.

Infantile pyoderma gangrenosum. A six month old female infant with pyoderma gangrenosum is reported. Pyoderma gangrenosum in an infant is rare. The child responded to pulse therapy with intravenous dexamethasone and intralesional triamcinolone acetonide.


Superficial mycoses in Saudi Arabia.

Superficial mycoses in Saudi Arabia. Between June 1988 and December 1990, 1018 cases of superficial mycoses were investigated. Diagnosis was confirmed by microscopic examination in 503 cases and the causal agent was isolated in 490 cases. Tinea capitis accounted for 47.7% (92.5% in children below 10 years of age). The frequency of other clinical types in descending order was pityriasis versicolor 25.8%, tinea corporis 9%, onychomycosis 5.8%, tinea pedis 4%, intertrigo 3.9% and tinea cruris 2.8%. Erythrasma was encountered three times and mixed piedra and trichomycosis axillaris once. Microsporum canis was the commonest aetiological agent, responsible for 46.9% of ringworm infections. Malassezia furfur was the next most common agent (26.5%) followed by Candida albicans (8.6%) and Trichophyton violaceum (8.2%). Other species were found less frequently. T.simii was isolated from four cases of tinea cruris and one each of tinea capitis and tinea corporis, and Piedraia hortae and Trichosporon beigelii from a case of mixed piedra infection.


A comparison between M.R.I. and C.T. in acute spinal trauma. Magnetic Resonance Imaging (MRI) at 0.3T and Computed Tomography (CT) were compared in the retrospective evaluation of 34 patients with acute spinal cord injury. MRI was highly accurate in the imaging of vertebral body fracture, and spondylitic changes, and is the method of choice for imaging ligament injury, traumatic disc protrusion and spinal cord compression. It was also useful for the identification of subtle subluxations in the sagittal plane. CT remains the method of choice for imaging neural arch fractures. MRI at 0.3T is a valid technique for assessing patients with acute spinal trauma.


A comparison between M.R.I. and C.T. in the investigation of neurological deterioration in longstanding spinal trauma. MRI at 0.3T and CT with myelographic contrast (CTM) were compared in the retrospective evaluation of 35 patients investigated for the development of new neurological symptoms following longstanding spinal cord injury. Compared with MRI, CTM was relatively accurate for the demonstration of spinal cord compression, but failed to identify 23% of patients with spinal cord atrophy, and 43% of patients with post-traumatic syrinx formation. However, 5 patients had unsatisfactory MR imaging, either due to motion or metallic artifact, and in 3 of these, CTM demonstrated a syrinx. Although MRI is the method of choice in the investigation of this problem, CTM may still be required for patients with an unsatisfactory MR examination. Magnetic Resonance (MR) imaging is now an established technique for imaging the spine, with accurate depiction of the spinal cord, as well as the adjacent soft tissues (1, 2). However, the cost of this technique, and its as yet limited availability in Australasia, has resulted in the necessity to demonstrate its superiority over other imaging modalities for any specific clinical problem (3). One of the major areas of impact of MR has been in the investigation of the problem of acute neurological deterioration in patients with past spinal trauma (4, 5, 6). Some of these patients will have treatable causes of deterioration, either a post-traumatic syrinx, or spinal cord compression (6), and MR can be used to image these conditions (7), which, until recently, were investigated with computed tomography with myelographic contrast medium (CTM), (8, 9).(ABSTRACT TRUNCATED AT 250 WORDS)


Cardiovascular evaluation in Turner syndrome: utility of MR imaging. Forty patients with karyotypically proven Turner syndrome were prospectively studied using magnetic resonance imaging (MRI) and echocardiography in order to determine the frequency of cardiovascular anomalies and to assess the utility of both imaging modalities as methods for cardiovascular evaluation in Turner syndrome. Cardiovascular anomalies were found in 45% of patients. A high absolute prevalence of bicuspid aortic valve (17.5%) and aortic coarctation (12.5%) were observed relative to comparable series. Of clinically significant abnormalities, three of five aortic coarctations and four of five ascending aortic dilatations were solely MRI detected and not evident at echocardiographic examination. MRI is thus seen as a valuable adjunct to echocardiography in the cardiovascular evaluation of Turner syndrome patients. The usefulness of MRI primarily relates to its ability to provide excellent visualisation of the entire thoracic aorta where a large proportion of clinically significant anomalies occur in Turner syndrome.


Liver CT: a practical approach to dynamic contrast enhancement. The aim of this study was to establish a practical, simple protocol that reliably produces high quality dynamic incremental computed tomography (CT) of the liver. We reviewed 90 patients randomly allocated into six different protocols. All had preliminary unenhanced scans followed by a dynamic incremental CT of the liver. An initial delay of 30 seconds was used from the commencement of the injection of Iopamiro 370. The groups were: 1. Pump infusion (a) 100 mls at 2 mls/sec scanning inferosuperiorly. (b) 100 mls at 2 mls/sec scanning superoinferiorly. (c) 100 mls at 1 ml/sec scanning inferosuperiorly. (d) 50 mls at 1 ml/sec scanning inferosuperiorly. 2. 40 mls hand injected bolus followed immediately by 60 ml pump infusion at 1.3 mls/sec scanning inferosuperiorly. 3. 50 mls hand injected bolus scanning inferosuperiorly. The parameters recorded were the degree of hepatic parenchymal and hepatic venous enhancement and the aortic--IVC difference at the last slice through the liver, all measured in Hounsfield units. The protocols using 100 mls of contrast produced approximately twice the parenchymal and hepatic venous enhancement compared with those using 50 mls. Approximately 60-90% of examinations using 100 mls produced scans through the entire liver during the bolus or nonequilibrium phase, deemed the most sensitive for the detection of focal lesions, compared with 13-33% of those using 50 mls. Equally satisfactory results were obtained using the relatively inexpensive Biotel power injector preceded by a 40 ml hand injected bolus, compared with using an Angiomat angiography infusion pump.(ABSTRACT TRUNCATED AT 250 WORDS)


The perivertebral collar--a new sign in lymphoproliferative malignancies. Nine patients with lymphoproliferative malignancies, one of whom had not been previously diagnosed, were found on CT examination for back pain to have partial or complete soft tissue perivertebral collars. The thoracic and or lumbar regions were involved in all. Only 3 had gross bony changes at the time, and in others the changes appeared so innocuous that in combination with the vague clinical symptoms their significance was underestimated. Five patients ultimately had episodes of cord compression, and in all nine the appearance of this spinal lesion appeared to be of grave prognostic significance. All 9 were dead within 1 year of the presentation of their spinal lesions. The observation of a perivertebral collar in the context of a known or suspected lymphoproliferative malignancy should therefore raise the strong suspicion of spinal involvement. The vertebrae should be examined on bone windows and the contents of the spinal canal on narrow windows to assess bony and epidural spread.


Pulmonary arteriovenous malformations: pathology, clinical features and treatment with balloon and coil occlusion. This paper discusses the cases of 5 patients who have had therapeutic occlusion of their pulmonary arteriovenous malformations (PAVM) performed radiologically at Alfred Hospital in the past 4 years. The salient pathological, clinical and radiological features of PAVM are also presented.


Accelerated thrombolysis facilitated by direct puncture of occluded prosthetic femoral grafts. Inability to access occluded grafts is a major limitation to successful thrombolysis and may even preclude it. This paper addresses the problem and offers a new technique of direct puncture of prosthetic grafts through which thrombolysis and angioplasty can be performed. These techniques resulted in accelerated thrombolysis in all 15 patients studied with no failures due to inability to attain graft access.


An evaluation of the effect of processing conditions on mammographic film contrast, fog levels and speed. While it is well established that extended development times and temperatures will increase mammographic film contrast and speed (1), little work has been done to date in extending this work to encompass all common screen-film types and to study the effect of processing chemistry variations on contrast speed results. This paper reports on four locally available mammographic films which, after exposure in conditions that closely simulate clinical conditions, have been developed with four different development chemicals as a function of development temperature and time. Three development times were used (23, 32 and 42 seconds) in combination with four development temperatures (32, 34, 36 and 38 degrees). The results support the previously published result of increased speed and contrast with extending development time and temperature. It was further found that, for some film types, the film contrast varied significantly over film density when developed with extended processing. Other film types, however, maintained high contrasts over large film density ranges. In some cases the increased contrast was accompanied by elevated film fog levels. The development of mammographic films in non recommended chemistries produced varying results, mostly detrimental, which demonstrated that selection of development chemistry as well as optimal development times and temperatures, is critical for good film performance.


Iodine-125 irradiation of choroidal melanoma: clinical experience from the Prince of Wales and Sydney Eye Hospitals. We examined the records of 53 patients treated for choroidal melanoma between 1985 and 1989. The aim of this study was to assess the safety and short-term results of iodine-125 episcleral plaque therapy. There were 28 males and 25 females, aged 20 to 77 years (median 61 years), treated for single tumours with a median diameter of 9 mm (range 5 to 15 mm) and with a median thickness of 4 mm (range 2 to 10 mm). The plaques containing iodine-125 seeds were chosen according to tumour size: 10 mm (16 patients); 15 mm (36 patients); 20 mm (one patient). All patients are alive at last follow-up (median 1.3 years, range 4 months to 3.3 years). Four patients underwent enucleation for melanoma progression. Thirty patients have developed some type of complication (more than one complication occurred in the same eye in 12 patients): retinitis (19), optic neuropathy (7); cataract (4), rubeosis iridis (2). Overall, visual acuity deteriorated in 32 patients, remained stable in 12 patients and improved in 9 patients. Iodine-125 plaque therapy appears to offer patients good prospects of tumour control and preservation of useful vision.


Primary squamous cell carcinoma of the breast. A patient with pure primary squamous cell carcinoma (SCC) of the breast is reported. The patient was a 72 year old female who presented with a 4 month history of an enlarging left breast mass. Surgery involved a radical mastectomy and this was followed by post-operative radiotherapy and chemotherapy. The patient died of extensive metastatic disease some four months after surgery. The various characteristics of SCC of the breast are briefly discussed. A sub-group of SCC of the breast is identified among reported cases in which the clinical course is characterised by a very rapid growth, extremely aggressive behaviour and early metastasis.


Percutaneous drainage of a thigh haematoma: case report of an unusual radiographic appearance. We present a case of fat necrosis in the thigh of a ten year old girl, resulting in unusual multiple, ovoid filling defects seen in the residual cavity following drainage of a subcutaneous haematoma. No similar cases have been found on review of the literature. The appearance is described to aid diagnosis at the time of initial cavity drainage, avoiding the need for further investigation.


Bilateral spondylolysis and associated dysplasia of C6. Cervical spondylolysis is a rare condition, characterised by the presence of a corticated cleft between the superior and inferior articular facets of the articular mass (1). This defect involves the cervical equivalent of the pars interarticularis of the lumbar spine. Associated dysplastic changes are present, suggesting that the lesion is congenital (1 and 2). This case report describes bilateral spondylolysis and associated dysplasia of C6 in an 18 year old female. The importance of this lesion lies in its differentiation from the more serious articular mass fracture or dislocation (1).


Post-laminectomy pseudomeningocele: an unusual cause of bone erosion. Pseudomeningocele is a rare complication of laminectomy, which can cause recurrent back pain with or without radicular signs. A case of bone erosion of the posterior vertebral elements by a pseudomeningocele is discussed.


Sonographic appearance of plasmacytoma of the testis. A case of solitary extramedullary plasmacytoma of the testis is presented demonstrating the appearances on ultrasound. The clinical implications of this diagnosis are discussed.


Scintigraphic diagnosis and computed tomographic localization of an accessory spleen following relapse of chronic immune thrombocytopaenia. Chronic immune thrombocytopaenia is an immunologically mediated disorder resulting in disordered platelet kinetics and potentially life-threatening thrombocytopaenia. Failure of medical therapy is an indication for splenectomy, and responses are seen in 80% of patients following this procedure. An important cause of relapse following splenectomy is the presence of an accessory spleen. We describe a patient with Hodgkin's Disease who developed chronic immune thrombocytopaenia despite previous splenectomy. A remission was induced with immunosuppressive therapy, but he later relapsed. An accessory spleen was detected using 99mTc denatured red blood cells and localized using computed tomography (CT). Resection of the accessory spleen resulted in clinical remission. Accessory spleens are often small in size. Combined modality imaging is recommended in the evaluation of patients with a possible accessory spleen.


Intrathoracic right kidney diagnosed by ultrasound. Intrathoracic kidneys are rare. A case is described in which the initial intravenous urogram performed for prostatism appeared to show a non-functioning right kidney. A subsequent ultrasound examination revealed that the right kidney was situated in the right hemithorax, well above the liver. Pelvic ectopic kidneys are common and standard teaching is to perform a full length film should an immediate or 5 minute renal area radiograph suggest an absent/non-functioning kidney. With the increasing use of ultrasound in the initial assessment of patients with prostatism, the possible intrathoracic location of a kidney should be remembered when there is failure to demonstrate a kidney in the abdomen or pelvis.


Jaundice: clinical practice in 88,000 liveborn infants. We reviewed jaundiced infants born between 1971 and 1989. Jaundice was diagnosed in infants whose serum bilirubin level was found to be 154 umol/l or greater. Of 88,137 livebirths, 10,944 (12.4%) were jaundiced. The most common aetiological factor was prematurity (20.3%), followed by ABO erythroblastosis (5.5%), sepsis (1.8%), Rh erythroblastosis (1.8%), bruising (1.3%), multifactorial (1.0%) and glucose-6-phosphate dehydrogenase deficiency (0.5%). In the remainder (67.8%) no cause was found or inadequate investigations were performed to determine a cause. During the period under review there was a significant increase (r = 0.91) in the proportion of newborn infants with jaundice of prematurity, in those not investigated (r = 0.92) and a decrease in the proportion with bruising (r = -0.90) as the cause. Phototherapy was used on 4,126 (37.7%) infants and exchange transfusion performed on 248 (2.3%). Causes of jaundice in infants requiring exchange transfusion were Rh erythroblastosis (108, 43.6%), ABO erythroblastosis (58, 23.4%), jaundice of prematurity (44, 17.7%) and a variety of causes in the remaining 38 (15.3%). Death occurred in 164 (1.5%) infants. In only 7 (4.3%), however, was the death possibly related to hyperbilirubinaemia or its treatment (Rh erythroblastosis (4), necrotizing enterocolitis following exchange transfusion (2) and pulmonary haemorrhage following exchange transfusion (1)). Phototherapy proved safe with no deaths attributable to its use.


Is there a lower limit for birth-weight/gestational age and antenatal steroid therapy? The aim of this study was to determine if there is a lower limit for birth-weight/gestational age below which antenatal steroid therapy may not improve fetal survival. The association between antenatal steroid therapy and survival to 2 years of age was assessed in 2 cohorts of children of birth-weight below 800 g or of gestational ages below 27 weeks. Antenatal steroid therapy was associated with significantly higher survival rates in infants of birth-weight 500-599 g and 700-799 g, and at gestational ages of 25 and 26 weeks. There were few survivors before 25 weeks and none below 500 g birth-weight. After adjustment for extraneous prognostic variables, antenatal steroid therapy was associated overall with approximately a doubling of the survival rates of infants of birth-weight 500-799 g, and of gestational ages 24-26 weeks. In the absence of maternal contraindications, if the goal is to deliver a surviving infant, this study suggests that the obstetrician may assist the survival chances of the tiniest and most immature infants by treating the mother with steroids before birth, with no apparent lower limit of birth-weight or gestational age.


Clinical versus ultrasound estimation of fetal weight. A prospective study was carried out on 50 patients who had their fetal weight estimated by 3 clinicians of different seniority and compared to the ultrasound estimated fetal weights using 3 different formulas. All the patients delivered within 24 hours of their clinical and ultrasound estimates. A wide range of birth-weights (1,800-4,500 g) was estimated among the 3 different races (Malay, Chinese and Indians). The results showed that there was no significant difference in birth-weight estimation amongst the 3 clinicians as well as between the 3 ultrasound formulas used. There was however significant difference between these 2 groups when compared with the actual birthweight with clinical estimation being superior to ultrasound estimation in our population. This level of significance did not extend beyond 4,000 g fetal weight (actual) thus making both clinical and ultrasound estimation of fetal weight equally accurate after 4,000 g. This has important implications for developing countries where there is a lack of technologically advanced ultrasound machines capable of doing sophisticated functions like fetal weight estimations but has experienced clinicians who could perform this function equally well if not better.


An assessment of key aetiological factors associated with preterm birth and perinatal mortality. The 4 main causes of preterm births in 303 women with consecutive deliveries in Flinders Medical Centre were premature rupture of the membranes (39%), spontaneous preterm labour (22%), pregnancy-induced hypertension (17%) and antepartum haemorrhage (12%). Premature rupture of the membranes occurred with equal frequency in singleton and multiple pregnancies and there was no difference in the frequency of this cause between the pregnancies with live outcomes and those with perinatal deaths. Spontaneous preterm labour was more common in multiple pregnancies (39%) than in singleton pregnancies (22%). One in 3 of the preterm births and 79% of the pregnancies with perinatal deaths occurred at less than 32 weeks' gestation. As it is unlikely that any single obstetric and social intervention will be able to reduce these causes of preterm birth research must continue to find markers to predict premature rupture of the membranes and spontaneous preterm labour.


Rates of caesarean section and neonatal mortality. A comparison of the yearly statistics of National Maternity Hospital (Dublin) and University Hospital (Newark) was undertaken for the years 1983-1989. The findings appear to indicate that after the elimination of major confounding factors, the substantially higher rates of Caesarean section in Newark (17.5% versus 5.8%) did not bring about a measurable reduction in the rate of neonatal losses. The impact of paediatric care upon the respective neonatal outcomes could not be assessed on the ground of the reviewed data.


The influence of maternal age on cesarean section rates. Caesarean section rates have risen in recent years and this has led to concern. Significantly different Caesarean section rates have been reported between different teaching hospitals. This study compares the Caesarean section rates between 2 Sydney teaching hospitals draining populations from different areas of Sydney. Raw figures showed significantly different Caesarean section rates (22.5% at Royal North Shore Hospital compared with 18.3% at Westmead Hospital). Each hospital has a significantly different case mix when maternal ages are compared. When Caesarean section rates were corrected for maternal age and parity, there was no significant difference. As maternal age is an important factor influencing Caesarean section rates, future reports on obstetric services should consider this factor in making comparisons.


Symptoms and signs with scar rupture--value of uterine activity measurements. To evaluate the symptoms and signs of scar rupture with special reference to intrauterine pressure measurement a retrospective analysis of labour records of those women who had trial of labour with a previous Caesarean scar in the National University Hospital over a period of 6 years (1985-1990) was carried out. Known symptoms and signs associated with scar rupture, cardiotocographic tracings and fetal and maternal outcome in these patients were studied. Of the 1,018 women with previous Caesarean scar (4.2% of our pregnant population at term) 722 (70.9%) had trial of labour; 70% delivered vaginally. There were 4 (0.55%) incomplete and 5 (0.69%) complete scar ruptures. All 9 women had an oxytocin infusion; 3 were diagnosed postdelivery (all 3 had complete ruptures); 3 of the 6 who had rupture prior to delivery had sudden reduction in uterine activity, 1 had scar pain and prolonged bradycardia and 2 had no symptoms or signs. Continuous cardiotocography with intrauterine pressure measurements may help to identify scar rupture early and may be of value especially in those who have an oxytocin infusion.


Vaginal delivery after caesarean section. In a prospective study of 318 consecutive pregnancies complicated by previous Caesarean section, 193 (61%) had an elective repeat Caesarean section, 125 (39%) had a trial of labour and 80 (64%) of these women achieved a vaginal delivery. The incidence of uterine rupture was 0.8% (1 of 125). The vaginal delivery rate was not influenced by the indication for the first Caesarean section (including cephalopelvic disproportion), birth-weight, health insurance status, use of epidural analgesia or oxytocin in labour. Perinatal morbidity was unaffected by the mode of delivery and maternal morbidity was comparable following elective and emergency repeat Caesarean section. Patients having a vaginal deliver spent significantly less time in hospital. We conclude that vaginal delivery after lower segment Caesarean section is safe and should be considered in most patients after a critical review of the indication for the first Caesarean section.


Narcotic addiction in pregnancy with adverse maternal and perinatal outcome. A retrospective case controlled study was carried out on 51 Chinese gravidas who had abused narcotics and who were delivered in a teaching hospital in Hong Kong. Heroin was the most commonly abused drug. The number of patients who changed from heroin to methadone was small. The major antenatal complications were late antenatal booking (average 28 weeks), prematurity (41%), small for gestational age baby (27.5%), antepartum haemorrhage (13.7%) and high prevalence of venereal disease (23.5%). The babies born to drug addicted mothers were on average 629 g lighter at birth, 5 cm smaller in head circumference and 7 cm shorter in body length. Neonatal withdrawal symptoms occurred in 83% of all drug exposed neonates. The perinatal mortality rate was 19.6 per 1,000 total birth which was 2.5 times that of the control group. There was one maternal death in our series. Drug addiction in pregnancy poses a major risk to both mother and child.


Intrapartum fetal stimulation testing.

Intrapartum fetal stimulation testing. Intrapartum vibroacoustic stimulation testing (VAST) had a sensitivity of 100%, a specificity of 59.6% and a positive predictive value of 27.6% for the detection of fetal acidosis in this study of 60 cases. The use of VAST could significantly reduce the requirement for fetal capillary blood sampling. However, fetal scalp stimulation (FSS) was found to be an unreliable test to exclude fetal acidosis.


Doppler ultrasound in pregnancies with hypertension. Doppler studies of the arcuate and umbilical arteries were performed longitudinally commencing at 24 weeks or less, in 29 pregnant women with chronic hypertension. The hypothesis was that pregnant women with chronic hypertension who develop superimposed gestational proteinuric hypertension and/or deliver small for gestational age babies are those who have abnormal arcuate and/or umbilical flow velocity waveforms. Abnormal arcuate waveforms occurred in 7 women and abnormal umbilical waveforms in 12. Nine babies were small for gestational age, and 6 of them had abnormal arcuate waveforms. Abnormal arcuate waveforms were significantly associated with the delivery of a small for gestational age baby (p = .001) and identified those babies where early delivery was necessary for fetal reasons. All small for gestational age babies had abnormal umbilical waveforms. Superadded gestational proteinuria (or preeclampsia) occurred in 8 pregnancies, however, only 3 had abnormal arcuate waveforms. An abnormal arcuate waveform did not predict the later development of gestational proteinuria. An abnormal umbilical waveform however, was associated with the subsequent development of gestational proteinuria. We consider that these findings need to be confirmed in a larger study.


The effect of consanguinity on pregnancy-induced hypertension. The aetiology of pregnancy induced hypertension (PIH) is unknown. Either an immunological or a genetic disorder are considered likely, with possibly an interaction between the two. If this were true, homozygosity would play an important role. Though consanguinity is believed to play a protective role, the effect of inbreeding on PIH has been inadequately studied. In South India consanguinity is common (26%). We prospectively studied 814 primigravidas of whom 213 had consanguineous marriages. The proportion of women who developed PIH was compared in the 2 groups of women with consanguineous and nonconsanguineous marriages. The odds of a patient with PIH being consanguineous was 1.12 with a 95% confidence interval of 0.72-1.75. Our observations suggest that consanguinity does not influence the incidence of PIH.


Norethisterone and gestational diabetes. In a single practice during the 21 years 1971-1991, the incidence of gestational diabetes in pregnancies in which norethisterone was prescribed was 32.4% (22 of 69) in comparison with 7.1% in pregnancies in which the women did not take norethisterone (137 of 1,684) (p < 0.001). Gestational diabetes was no less severe (degree of hyperglycaemia, need for insulin therapy) when associated with norethisterone. However, follow-up revealed that gestational diabetes when associated with norethisterone had a lesser risk of emerging diabetes mellitus and impaired glucose tolerance. Masculinization of a female fetus occurred in 5 of 39 (12.8%) exposed to norethisterone; all were cases of clitoral hypertrophy not requiring surgical treatment. Norethisterone in these 69 pregnancies accounted for 33.3% (5 of 15) cases of clitoral hypertrophy diagnosed in 100,756 consecutive births.


Hypothyroidism complicating pregnancy.

Hypothyroidism complicating pregnancy. In this report we describe 26 pregnancies complicated by hypothyroidism cared for over 6.5 years at AIIMS, New Delhi. In 2 women hypothyroidism was diagnosed during pregnancy; others were diagnosed before pregnancy and continued to receive thyroxine replacement therapy throughout pregnancy. The thyroxine treatment needed readjustment in 7 (26.9%) pregnancies to maintain euthyroidism. Maternal complications included anaemia (23.0%), pregnancy induced hypertension (26.9%), postpartum haemorrhage (7.7%), intrauterine growth retardation (15.4%), postdatism (30.8%), and deficient lactation (19.2%). Perinatal mortality was 3.9%. No case of stillbirth occurred probably because of intensive fetal monitoring and timely termination of pregnancies on evidence of intrauterine fetal compromise. One neonatal death occurred due to fetal thyrotoxicosis. In these cases close surveillance during pregnancy is needed to maintain optimum thyroid hormone concentration, and intensive fetal monitoring is required to achieve a good perinatal outcome.


Indomethacin for the treatment of polyhydramnios: a case of constriction of the ductus arteriosus. Prenatal administration of indomethacin for the treatment of polyhydramnios at 27 weeks' gestation resulted in the rapid restoration of normal amniotic fluid volume. However, after 16 days therapy, fetal echocardiography revealed constriction of the fetal ductus arteriosus which did not reverse during the 17 days after the therapy was discontinued. The constriction resulted in right heart failure but no long-term effects on the infant after birth. Indomethacin is a powerful treatment for polyhydramnios but its use requires close monitoring of the fetal heart.


Campylobacter jejuni in pregnancy.

Campylobacter jejuni in pregnancy. Case notes of pregnancies with proven Campylobacter jejuni infections were collected from 2 Queensland teaching hospitals and reviewed. Of these cases, 2 pregnancies (3 fetuses) resulted in stillbirths, 2 neonates required treatment with antibiotic therapy within 2 days of birth, while the remaining 2 pregnancies were treated at the time of the infection and were not associated with adverse outcome. Maternal Campylobacter infection should be actively sought for in the patient with suspected infectious diarrhoea.


Pregnancy following infertility.

Pregnancy following infertility. Pregnancies of 112 patients who had conceived after a history of a minimum of 2 years of infertility were compared to an equal number of matching controls without prior infertility to find out any risk of increased pregnancy complications. These patients were at a significantly higher risk of developing first trimester bleeding, antepartum haemorrhage and intrauterine fetal death. Also there were higher rates of preterm delivery and Caesarean section. The patients in the study group had a significantly higher number of stillborn babies. The incidence of other complications such as ectopic pregnancy, multiple pregnancy, and medical complications was also higher in these patients but the difference was not statistically significant.


Diagnostic value of magnetic resonance imaging in gynaecology. In this study 23 patients with various gynaecological pathologies were evaluated. Ultrasonography and magnetic resonance imaging were performed in all cases, but only 14 were evaluated with computed tomography. On the basis of ultrasonography, 4 patients were labelled as having malignant ovarian tumours, however, this diagnosis was confirmed by magnetic resonance imaging in only 1 of the 4. Magnetic resonance imaging also determined the correct diagnosis in a patient with endometrioma whereas computed tomography showed only a simple cyst, and ultrasonography diagnosed a subserous myoma. Tumour was demonstrated by magnetic resonance imaging in 2 patients with cervical carcinoma although computed tomography and ultrasonography had previously shown no tumour mass in these patients. It was concluded that magnetic resonance imaging is much superior to computed tomography and ultrasonography in gynaecological diagnosis. This advantage results from the correct detection of the contents of ovarian cysts, the number and localization of uterine leiomyomas in T2 scans, invasion of uterine malignancies and differential diagnosis of subserous uterine leiomyomas from ovarian tumours.


The boldest procedure possible for checking the bleeding--a new look at an old operation, and a series of 13 cases from an Australian hospital. Ligation of the internal iliac (hypogastric) arteries in cases of massive obstetric and gynaecological haemorrhage can be a life-saving operation, but it has never been widely practised in the British gynaecological tradition. There may be historical reasons for this. A series of 13 cases is presented from one Australian hospital over a 5-year period, and a very low rate of Caesarean hysterectomy is demonstrated. A wider knowledge of the technique is recommended. Alternative methods of management, including angiographic embolization and the use of prostaglandins are discussed.


Primary adjunctive whole abdominal radiotherapy in epithelial ovarian cancer: results of 10-years' experience. During a 10-year period from January 1, 1979, 59 patients out of a total of 203 undergoing definitive treatment for epithelial ovarian cancer were managed with primary adjuvant whole abdominal radiotherapy after initial cytoreductive surgery. The median survival of this group was 53 months. The serious morbidity rate was approximately 8% with 4 laparotomies for bowel complications and 1 death following radiation related liver failure. This form of adjuvant therapy in appropriately selected patients with minimal residual disease merits further evaluation against other forms of therapy such as systemic or intraperitoneal chemotherapy.


Urethral instability.

Urethral instability. Urethral instability is still evolving as a clinical entity. Using pressure variation of 15 cm water or more at the point of maximum urethral pressure (MUP), urethral pressure profilometry on patients referred for urodynamic assessment for lower urinary tract symptoms revealed urethral instability in 6.4% of 608 patients. The close association between urethral and detrusor instability was noted. Urethral instability appears to be a cause of frequency and urgency of micturition, and its presence increase the risk of urinary incontinence.


Balance and gait analysis after 30 days -6 degrees bed rest: influence of lower-body negative-pressure sessions. Five volunteers took part in -6 degrees head-down bed-rest experiments for 30 d. In the first experiment, three subjects underwent several sessions of lower-body negative-pressure (LBNP) per day, with two others serving as controls. In the second, the LBNP group of the first experiment became the control and vice versa. Two experimental protocols analyzed the bed-rest-induced modifications of balance and gait and the efficiency of LBNP in counteracting these modifications. A kymographic method allowed the measurement of walking parameters. Anteroposterior and lateral sways were successively studied with both a force platform (static condition) and a rocking platform (dynamic condition). The tests were performed 2 d before the bed-rest period, and over the 1st, 3rd and 4th days of the recovery period. When the subjects were controls, bed rest decreased step length, walking velocity, and balance stability. LBNP completely counteracted the bed-rest-induced modifications of gait and static balance and of dynamic balance for the lateral sway. As LBNP was ineffective in counteracting the modifications of the anteroposterior sway, dynamic balance deficiency was independent of the beneficial effect of LBNP on the decreased orthostatic tolerance induced by -6 degrees head-down bed rest. The results indicate that head-down bed rest, like spaceflight, induces certain sensorimotor changes involved in the decrease of gait and balance performance.


Hyperbaric oxygen treatment for carbon monoxide poisoning in pregnancy: a case report. Carbon monoxide (CO) poisoning is one of the most common forms of poisoning in the United States. When CO poisoning occurs in the pregnant patient, it is extremely toxic to the mother and fetus in terms of central nervous system disorders and delayed central nervous system sequelae. Controversy exists in treating the pregnant patient with hyperbaric oxygen (HBO) because of the unknown effects of high partial pressures of oxygen on the fetus. HBO therapy is beneficial in CO poisoning because of its effect of first increasing oxygen concentration and causing a shift in the oxygen dissociation curve from the left to the right. Second, by causing a diminished CO interaction with cytochrome oxidase, HBO allows mitochondria to use oxygen more effectively. Third, HBO may reduce lipid peroxidation which may be responsible for neurological deterioration and delayed central nervous system sequelae. Fourth, decreased CO influence through HBO may reduce changes in the myocardium as a result of CO poisoning, if cardiovascular disease is already present. A case study of successful HBO therapy used during pregnancy is presented and effects of CO on the fetus are discussed.


Psychiatric diagnoses aboard an aircraft carrier. A descriptive study was conducted for 150 consecutive patients with a psychiatric diagnosis evaluated over 11 months by the medical staff onboard an aircraft carrier. Patients with sole diagnosis of alcohol abuse or dependence were excluded. Axis II diagnoses, or personality disorders, were more common (N = 120) than Axis I diagnoses (N = 46). The most common Axis I diagnoses were adjustment disorder and major depression. Axis II diagnoses were significantly more likely (OR = 7.33, 95% CI 4.45-12.16, p = 0.000) in sailors less than 23 years of age compared to ship's population. Suicide behavior was demonstrated in 68% (102/150) of the patient population. This study emphasized the requirement for extensive psychiatric training for the clinical aerospace medicine specialists providing operational support to aircraft carrier crews.


Radiated electric field measurements in U.S. Army helicopters. Aircraft systems and medical devices generate electromagnetic fields. Electromagnetic interference (EMI) can cause faulty operation of aircraft systems or medical devices and endanger patients or aircraft crewmembers. A ground and inflight study was conducted to describe the electromagnetic fields in typical operations. Broadband isotropic field sensors measured electric fields from 5 kHz to 3 MHz, 3 to 500 MHz, and 0.5 MHz to 6 GHz. Fields were measured at 0.5 m space intervals in JOH-58A, JUH-1H, and JUH-60A helicopters with systems off, operating RPM, 5-ft hover, 50-ft hover, and cruise. Electric fields in the environment were homogeneous and less than 0.1 V/m. Fields in the helicopters increased during ascent, but remained less than 2 V/m except during radio transmissions. EMI effect of the Physio Control Lifepack 8 was demonstrated during FM radio transmission. The results are useful in evaluating electromagnetic emissions and predicting operations that may result in an inflight malfunction of a medical device or aircraft system.


Potential hazards of high anti-Gz suit protection. Although balanced positive pressure breathing increases protection by G suits and reduces fatigue during sustained high Gz exposures, it does not prevent dependent pulmonary right-to-left shunts (arterial hypoxemia) and potentially dangerous distention of nondependent alveoli. An incident of acute incapacitating mediastinal emphysema in a healthy young man during a sustained exposure to 5.5 Gx documents this possibility. This, plus neurogenic bradycardia during sustained high Gz exposures without pressure breathing, suggests that testing of full counterpressure to neck level suits at sustained > 9 Gz exposures may be hazardous. Fully instrumented studies of animal surrogates with comparable thoracic dimensions are indicated.


Pilot performance with blood alcohol concentrations below 0.04%. The effects of a low (less than 0.04%) BAC on pilot performance were investigated in a series of four experiments in which pilots flew a light aircraft simulator under alcohol and placebo conditions. The mean BACs of subjects when starting and finishing the test sessions were 0.037% and 0.028%, respectively. Two of the experiments involved demanding flight tasks under instrument meteorological conditions: complicated departure, holding, and approach procedures in one case; and VOR-use intersection problems in the other. The other two experiments involved ILS approaches under turbulence, cross wind, and simulated wind shear conditions that imposed heavy control-task loads on the pilots. Significant alcohol effects were found, but only under the heaviest workload conditions. During posttest interviews 75% of the pilots reported physical and/or mental effects due to alcohol.


Success rate analysis of Navy SERGRAD flight training. SERGRADS are selectively retained graduates of Naval Flight Training who become flight instructors during their first tour as Naval Aviators. A perception exists that SERGRADS have more difficulties than newly designated pilots during subsequent training in the Fleet Replacement Squadrons (FRS). A preliminary inquiry at the F/A-18 FRS revealed that former SERGRADS appear to experience a higher rate of failure on their initial carrier qualification attempt during FRS training. This study examined the SERGRAD experience and compared their performance to trainees from other sources. Although significant differences were found between groups for Fleet Replacement Squadron flight grades and Training Command composite grades, no significant differences were found between the groups for Training Command carrier qualification grades or Fleet Replacement Squadron carrier qualification. Thus, the data do not support the hypothesis that SERGRADS have more problems or are poorer aviators than F/A-18 students from other sources.


Time to detection of circulating microbubbles as a risk factor for symptoms of altitude decompression sickness. This study investigated the association between time at onset of circulating microbubbles (CMB) and symptoms of altitude decompression sickness (DCS), using Cox proportional hazard regression models. The study population consisted of 125 individuals who participated in direct ascent, simulated extravehicular activities profiles. Using individual CMB status as a time-dependent variable, we found that the hazard for symptoms increased significantly (at the end of 180 min at altitude) in the presence of CMB (Hazard Ratio = 29.59; 95% confidence interval [95% CI] = 7.66-114.27), compared to no CMB. Further examination was conducted on the subgroup of individuals who developed microbubbles during the test (n = 49), by using Cox regression. Individuals with late onset of CMB (> 60 min at altitude) showed a significantly reduced risk of symptoms (hazard ratio = 0.92; 95% CI = 0.89-0.95), compared to those with early onset (< or = 60 min), while controlling for other risk factors. We conclude that time to detection of circulating microbubbles is an independent determinant of symptoms of DCS.


Failure of the straight-line DCS boundary when extrapolated to the hypobaric realm. The lowest pressure (P2) to which a diver can ascend without developing decompression sickness (DCS) after becoming equilibrated at some higher pressure (P1) is described by a straight line with a negative y-intercept. We tested whether extrapolation of such a line also predicts safe decompression to altitude. We substituted tissue nitrogen pressure (P1N2) calculated for a compartment with a 360-min half-time for P1 values; this allows data from hypobaric exposures to be plotted on a P2 vs. P1N2 graph, even if the subject breathes oxygen before ascent. In literature sources, we found 40 reports of human exposures in hypobaric chambers that fell in the region of a P2 vs. P1N2 plot where the extrapolation from hyperbaric data predicted that the decompression should be free of DCS. Of 4,576 exposures, 785 persons suffered decompression sickness (17%), indicating that extrapolation of the diver line to altitude is not valid. Over the pressure range spanned by human hypobaric exposures and hyperbaric air exposures, the best separation between no DCS and DCS on a P2 vs. P1N2 plot seems to be a curve which approximates a straight line in the hyperbaric region but bends toward the origin in the hypobaric region.


Electromyographic activity while performing the anti-G straining maneuver during high sustained acceleration. The purpose of this study was to measure the muscle activity during performance of the anti-G straining maneuver (AGSM) at high sustained acceleration stress (+Gz = head-to-foot inertial loading). Ten males were exposed on three separation occasions to a rapid onset rate of 6 + Gz. Subjects wore standard United States Air Force (USAF) anti-G trousers and performed the AGSM until perceived fatigue or until achieving light loss criteria. During each exposure, surface electromyography (EMG) was recorded from the erector spinae, external oblique, bicep femoris, vastus lateralis, and lateral gastrocnemius muscles. The normalized root-mean squares (RMS) and mean power frequency (MPF) for each muscle were calculated and tested for significant differences with an analysis of variance (ANOVA) procedure. The results of this study showed that mean amplitude decreased during the AGSM (35.40%) while MPF showed no significant change. The EMG amplitude of lower extremity muscles decreased (61.45%) while the amplitude of trunk muscles decreased slightly (3.45%). These results indicate that during the performance of the AGSM, motor unit recruitment in lower extremity muscles decrease without evidence of fatigue.


The effects of hypoxia on auditory reaction time and P300 latency. A predominant feature of hypoxia is that it slows information processing. Evidence is accumulating that early visual mechanisms are an important locus of this slowing. Audition is believed to be insensitive to hypoxia, implying relatively less slowing with auditory stimuli. Subjects breathed air or a low oxygen mixture (65% arterial oxyhemoglobin saturation) while RT (reaction time) and the EEG were collected to oddball binaural tone pips at 500 Hz, 1000 Hz, and 4000 Hz. Hypoxia slowed RT and the event-related brain potential P300 in a correlated manner and by an identical amount that was generally independent of frequency. On the assumption that P300 indexes the time to evaluate a stimulus and RT indexes this time plus the time to select and execute a response, stimulus evaluation is implicated as a major locus of slowing in this experiment. The amount of slowing was comparable to that found previously with RT and P300 to visual stimuli. It may be that audition is more sensitive to hypoxia than is currently believed, at least where the speed of processing is concerned.


Seasonal effects on human physiological adaptation factors, thermotolerance and plasma fibronectin. Plasma fibronectin (PF) influences shock survival and basal levels increase with active conditioning that improves human physiological adaptation factors (PAF) and thermotolerance (TT). To evaluate further PF's relationship with PAF and TT, the effects of passive conditioning with seasonal change (spring vs. summer) in New England on PAF, TT, basal PF level and PF level during hot-humid exercise (HHE; bicycling; 40 +/- 4% VO2max; 35 degrees C; 70% rh; 45 min) were examined in male subjects (28.2 +/- 1.6 years; N = 7; values are means +/- SE). The spring and summer studies were separated by 2 months. In addition, 2 months prior to the spring study, a winter basal PF pre-screening was conducted. Winter (287 +/- 36 micrograms/ml), spring (272 +/- 21 micrograms/ml), and summer (278 +/- 19 micrograms/ml) basal PF levels were similar. The PF response during HHE was unremarkable with seasonal change. PAF were improved, since blood volume (6266 +/- 276 vs. 5895 +/- 251 ml), plasma volume (3896 +/- 198 vs. 3601 +/- 165 ml) and HHE sweat rate (18.7 +/- 5.5 vs. 12.9 +/- 6.4 ml/min) were elevated (p < 0.05) in the summer compared to the spring. However, this was not accompanied by improved TT, since spring and summer rectal temperatures during HHE were similar, while summer heart rate was elevated (p < 0.05) compared to the spring. In contrast to active conditioning, passively-induced improvements in PAF were not associated with elevations in TT or PF level. Unlike PAF, PF elevations might only occur when the conditioning resulted in increased TT, which suggests a potential for PF as a TT marker.


Accuracy of aimed arm movements in changed gravity. We studied the accuracy of aimed arm movements in normal gravity, and during the hypergravity (hyper-G) and microgravity (micro-G) episodes of KC-135 parabolic flights. Subjects pointed at mirror-viewed targets without sight of their arm, and final pointing position was measured by a digitizing pad. Compared with the normal gravity (normal-G) baseline, subjects pointed consistently higher in hyper-G, and still higher in micro-G. Results were not different if subjects viewed targets only during normal-G and pointed at their memorized position under changed gravity (changed-G); this suggests that the "elevator illusion" played a minor role in our study. The observed impairments were attributed to degraded proprioceptive feedback and/or inappropriate motor programs in changed-G. Pointing accuracy improved movement-to-movement but not parabola-to-parabola, indicating that prolonged exposure is needed for sustained adaptation.


Effects of acute exercise on attenuated vagal baroreflex function during bed rest. We measured carotid baroreceptor-cardiac reflex responses in six healthy men, 24 h before and 24 h after a bout of leg exercise during 6 degrees head-down bed rest to determine if depressed vagal baroreflex function associated with exposure to microgravity environments could be reversed by a single exposure to acute intense exercise. Baroreflex responses were measured before bed rest and on day 7 of bed rest. An exercise bout consisting of dynamic and isometric actions of the quadriceps at graded speeds and resistances was performed on day 8 of bed rest and measurements of baroreflex response were repeated 24 h later. Vagally-mediated cardiac responses were provoked with ramped neck pressure-suction sequences comprising pressure elevations to +40 mm Hg, followed by serial, R-wave triggered 15 mm Hg reductions, to -65 mm Hg. Baroreceptor stimulus-cardiac response relationships were derived by plotting each R-R interval as a function of systolic pressure less the neck chamber pressure applied during the interval. Compared with pre-bed rest baseline measurements, 7 d of bed rest decreased the gain (maximum slope) of the baroreflex stimulus-response relationship by 16.8 +/- 3.4% (p < 0.05). On day 9 of bed rest, 24 h after exercise, the maximum slope of the baroreflex stimulus-response relationship was increased (p < 0.05) by 10.7 +/- 3.7% above pre-bed rest levels and 34.3 +/- 7.9% above bed rest day 7. Our data verify that vagally-mediated baroreflex function is depressed by exposure to simulated microgravity and demonstrate that this effect can be acutely reversed by exposure to a single bout of intense exercise.


Chronic pancreatitis and diabetes.

Chronic pancreatitis and diabetes. Chronic pancreatitis is defined by a persistent destruction of the pancreatic parenchyma replaced by fibrosis. The lesions generally start in the exocrine gland, islets being attacked later in the fibrosis. The two most frequent forms are: 1. Chronic calcifying pancreatitis which is a pancreatic lithiasis responsible for more than 95% of chronic pancreatitis. In its most frequent form, calculi are built up of more than 98% calcium salts together with fibres of a degraded residue of lithostathine, a secretory protein. This disease is related (i) in most countries to alcohol, protein, fat and tobacco and (ii) in certain tropical countries to malnutrition (low-fat, low-protein diet) for some generations. A causative role for cassava and kwashiorkor is improbable. The mechanism of calcium precipitation is partly explained by the calcium-saturation of pancreatic juice and the decreased biosynthesis of lithostathine S, the secretory protein preventing crystallization. As a rule, diabetes (and steatorrhoea) appear after a clinical evolution characterized by recurrent attacks of upper abdominal pain, generally lasting some days with transiently increased concentrations of pancreatic enzymes in serum. When diabetes appears, pain frequently disappears. Complications are mostly observed in the first 10 years of clinical evolution. 2. Obstructive pancreatitis is due to an obstacle (tumours, scars) in the pancreatic duct. It is rarely a cause of diabetes. Diabetes due to chronic pancreatitis is characterized by the low incidence of ketosis and the high incidence of insulin-induced hypoglycaemia. Patients are generally thin. Serum insulin levels, either basal or stimulated, are decreased. Glucagon is less affected. Angiopathies and retinopathies are less frequent than in non-insulin-dependent diabetes. Neural complications are fairly frequent. The diagnosis is generally easy because diabetes appears at a late stage of the disease. The treatment generally requires insulin.


Diabetes mellitus and cystic fibrosis.

Diabetes mellitus and cystic fibrosis. There is a high prevalence of diabetes mellitus in patients with CF and this is likely to increase in the future as more patients are surviving into adult life. In view of this all CF clinics should routinely screen for diabetes mellitus. The prevalence of diabetes mellitus in adult CF patients is higher than in children, and the onset is commonly insidious. The diabetes seen in CF is not classical Type 1 diabetes or Type 2 diabetes and could more helpfully be called cystic fibrosis-related diabetes (CFRD). Treatment is by oral hypoglycaemic agents or insulin. It is not appropriate to control patients by diet alone. Dietary advice to CF diabetic patients is not the same as that given to non-CF diabetic patients. Microvascular complications have now been reported and careful monitoring of all CF patients with diabetes should be undertaken.


Diabetes and adrenal disease.

Diabetes and adrenal disease. Disorders of the adrenal cortex and medulla can result in glucose intolerance or overt diabetes mellitus. Cushing's syndrome, characterized by excessive secretion of glucocorticoids, impairs glucose tolerance primarily by causing insulin resistance at the post-receptor level. On the other hand, phaeochromocytoma and hyperaldosteronism, via the respective actions of catecholamines and hypokalaemia on the pancreatic beta-cell, impair glucose tolerance primarily by inhibiting insulin release. The glucose intolerance associated with these adrenal disorders is usually only mild to moderate in severity. Marked hyperglycaemia, glycosuria, and polyuria are uncommon and ketosis is rare. Moreover, the late complications of diabetes mellitus are distinctly uncommon in patients with these disorders, and the prognosis for morbidity and death is usually that of the underlying disease and not that of diabetes mellitus. The impaired glucose tolerance induced by all three of these adrenal disorders usually returns to normal once the underlying aetiology has been cured. These factors must guide the clinician in treatment of these secondary forms of diabetes, and suggest that tight (near normal) blood glucose control may not be an appropriate goal in patients with these disorders. The relationship between adrenal androgens and glucose tolerance is more uncertain. Several studies in humans have demonstrated an acute decline in serum concentrations of the adrenal steroids DHEA and DHEA-sulfate in response to experimentally-induced hyperinsulinaemia, but the regulatory role of insulin on adrenal androgen metabolism in normal physiology or disease remains speculative. In several animal models DHEA appears to exert potent anti-obesity and anti-diabetogenic actions, but such effects have yet to be demonstrated in humans. Human studies of DHEA are limited, and more research needs to be conducted to determine whether the observations made in animal models will prove applicable to man.


Drug-induced diabetes.

Drug-induced diabetes. The only drugs which commonly cause diabetes during therapeutic use are the anti-hypertensive vasodilator diazoxide, and corticosteroids in high doses such as those used to palliate intracranial tumours. Thiazide diuretics have in the past been used in higher doses than necessary to treat hypertension, and the lower doses now used probably carry only a slight risk of inducing diabetes. The risk from beta-blockers is also quite small, but there is some evidence that thiazides combined with beta-blockers may be more likely to cause diabetes than either drug alone. The combination is probably best avoided in patients with a family history of non-insulin-dependent diabetes. The effect of the low-oestrogen combined oral contraceptive pill seems to be slight, and it presents a risk only to women who have had gestational diabetes. Bodybuilders who take enormous doses of anabolic-androgens can develop impaired glucose tolerance. Several drugs, including theophylline, aspirin, isoniazid and nalidixic acid can cause transient hyperglycaemia in overdosage, but only streptozotocin, alloxan and the rodenticide Vacor are likely to cause permanent diabetes.


Diabetes secondary to genetic disorders. Diabetes may be associated with many genetic disorders. The scientific importance of these often rare disorders resides in the insight they may provide into the possible mechanisms of common diabetes. The type of diabetes varies in these syndromes. Non-insulin-dependent diabetes (NIDDM), clinically similar to common NIDDM, may be found in some syndromes (e.g. Werner's syndrome). In others there may be considerable insulin resistance, such as that present in ataxia telangiectasia. Extreme insulin resistance due to abnormal insulin receptor function is found in the Mendenhall syndrome. The mechanism of diabetes is more obscure in acute intermittent porphyria (AIP), although haem deficiency affecting the cytochrome chain raises interesting possibilities. In glycogen storage disease type I, the diabetes is associated with insulinopenia, following an earlier period in the disease when hypoglycaemia is the rule. IDDM, clinically similar to the common form, is present in the autoimmune polyglandular syndromes. Although a change in the lean:fat ratio is common in many neuromuscular disorders, mechanisms other than insulin resistance would seem to operate. The increased incidence of diabetes in heterozygotes for some of these genetic disorders raises the possibility that many common diabetics are, in fact, heterozygotes for some other disorder. The increased frequency of diabetes in Klinefelter's syndrome, Turner's syndrome and possibly Down's syndrome leads to the hypothesis that non-disjunction may, in some way be associated with the predisposition to diabetes. In several syndromes there is an increased incidence of diabetes in otherwise unaffected relatives of individuals with these syndromes. It is impossible to assess what proportion of common NIDDM or IDDM is made up of heterozygotes for these genetic syndromes.


Incidence of trypanosomes and productivity of settled Fulani cattle in Anambra State, southern Nigeria. In the tropical rain forest zone of Southern Nigeria Fulani zebus were investigated for the incidence of trypanosomes. The animals had been settled in this area for at least 3 years. Although cattle in the southern part of the country exhibited a significantly higher incidence of trypanosomes than cattle in the northern parts they are more robust and healthier and showed a higher reproductive performance than cattle in Northern Nigeria. Thus the tse-tse fly attacks are no hindrance to cattle production in Southern Nigeria, Anambra State.


Some physiological aspects of repeat breeding in Holstein Friesians and its improvement under Egyptian environment. The serum albumin concentration and the albumin-globulin ratio had a significant effect on the rate of repeat breeding. In repeat breeders, low concentrations were found of albumin, progesterone, phosphorus, zinc, and glucose. The glycogen content of the cervical mucus was significantly lower in the repeat breeders. Treating repeat breeders with prostaglandin F2 alpha had positive effects on the parameter values.


Adenine phosphoribosyl transferase polymorphism in baboons. Two allelic isozymes of adenine phosphoribosyl transferase (APRT) were detected by starch gel electrophoresis of baboon hemolysates. Extensive family data verified autosomal codominant inheritance. The gene frequencies of five subspecies of baboons differed significantly. The activity of erythrocyte APRT is sufficiently high to enable the use of this enzyme as a sensitive marker for assessing chimerism in research involving bone marrow transplantation.


A polymorphism detected in a variable number of tandem repeats (VNTR) of the seminal vesicle secretion (SVS) IV gene in inbred rats. The second intron of the rat SVS IV gene contains a tandem repeat region of 20-bp sequences. This region was amplified using the polymerase chain reaction to detect variations. Three alleles, characterized by amplified fragments of 750, 490, and 390 bp, respectively, were found in 24 strains examined. This variation segregated in F1 and backcross progeny in an autosomal codominant manner. We tentatively designated this locus Svs-4. Analysis of linkages between the Svs-4 locus and other loci revealed that it was closely linked to the Svp-1 (less than 2.9%) and the a (10.0 +/- 6.7%) loci, which belong to rat linkage group IV. The Svp-1 and Svs-4 loci, however, were differently distributed among the inbred rat strains.


The relationship between homozygosity level and animal physiology: iron content of plasma and whole blood as well as total iron binding capacity by transferrin (TIBC) in rats of various inbreeding coefficient. Male and female wild Norway rats (Rattus norvegicus Erxleben) and male and female albino outbred rats (Ipf:RIZ) were crossbred. These animals were the control, noninbred group (0% inbred). By systematic full-sib mating, two experimental groups (50 and 91% of inbred) were raised. Half of each group (both males and females) was exposed to physical stress (3 days of starvation and 3 hr of swimming). The other half of each group was ether anesthetized to collect blood. The iron content of plasma and whole blood, as well as the total iron binding capacity, was determined by the Atom-Spec method. A significant decrease in the iron content of plasma and whole blood as well as the TIBC was observed by an increase in the inbreeding coefficient. Stress significantly influenced the iron content of plasma and whole blood as well as the TIBC, whereas the sex of the rats affected the whole-blood iron concentration and TIBC. Moreover, some double interactions had an impact on the iron content and TIBC. The interactions were as follows: plasma--inbreeding level and stress; whole blood--sex and stress; and TIBC--inbreeding level and sex.


Analysis of L-alanine:2-oxoglutarate aminotransferase isozymes in maize. Isozyme analysis of L-alanine:2-oxoglutarate aminotransferase (ALT) in maize indicates that there are three genes encoding this enzyme activity. Two of the gene products interact with each other to form heterodimers, while the third gene product does not interact with the other two. Another isozyme that appears after gel electrophoresis and ALT staining is shown to be glutamate dehydrogenase-1. Anaerobic treatment does not result in increased ALT levels, indicating that the previously reported increase in alanine levels caused by this treatment may be due to increases in the level of pyruvate, a substrate of ALT.