Showing papers in "The Medical Journal of Australia in 1982"
TL;DR: There is concern that increasing use of vancomycin will select vancomYcin‐resistant strains of MRSA, so that, in the near future, there may no longer be any effective antibiotic therapy against hospital staphylococci.
Abstract: During 1979, the Victorian Health Commission received reports of a rising proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates from an increasing number of institutions. At least 31 metropolitan hospitals were involved, and six of these reported MRSA totaling between 20% and 40% of all Staph. aureus isolates. Since that time, the problem has continued. In some university teaching hospitals, strains of MRSA now cause from 200 to 300 new cases of hospital-acquired infection each year. Sepsis occurs mainly in patients who underwent surgery, premature neonates and in the immunocompromised or debilitated patients. The organism involved is multiresistant. Recent isolates show increasing resistance, particularly against gentamicin, chloramphenicol and, more lately, fusidic acid and rifampicin. Only vancomycin can be relied upon for empirical treatment. There is concern that increasing use of vancomycin will select vancomycin-resistant strains of MRSA, so that, in the near future, there may no longer be any effective antibiotic therapy against hospital staphylococci.
195 citations
TL;DR: One hundred and eleven cases of Q fever which were referred over a 20‐year period are described, including description of the clinical illness, epidemiology, serological findings and management.
Abstract: One hundred and eleven cases of Q fever which were referred over a 20‐year period are described, including description of the clinical illness, epidemiology, serological findings and management. Unusual features reported here are a long incubation period, rash, haemolysis and abnormal findings in cerebrospinal fluid. Special emphasis is given to the course of the disease, treatment, and serological follow‐up investigations.
148 citations
TL;DR: The literature does not support the view that patients invariably become symptom‐free and resume work within months of the finalisation of their claims, and up to 75% of those injured in compensable accidents may fail to return to gainful employment two years after legal settlement.
Abstract: The literature dealing with the effect of legal settlement of compensation claims on disability and return to gainful employment is reviewed. The literature does not support the view that patients invariably become symptom-free and resume work within months of the finalisation of their claims. Up to 75 per cent of those injured in compensable accidents may fail to return to gainful employment two years after legal settlement. Factors associated with a poor prognosis include older age at settlement, low back injury and loss of libido. (Author/TRRL)
140 citations
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TL;DR: There appears to be no basis for concluding that cimetidine causes granulocytopenia in patients with uncomplicated acid-peptic disease, and the role of cimet idine as opposed to that of underlying disease states and other drugs remains uncertain.
Abstract: simple, proven K+ and CIreplacement with less problem potential than \"K-saving\" drugs. Cimetidine and agranulocytosis Sir : Reading the case of agranulocyto sis reported by Dr R. M . Crapper (MJA, September 5, 1981), we were surprised to not e that the clear recommend at ion in our prescribing information to reduce do sage of cimetidine in patients with renal impairment had not been observed. Indeed , in such a patient with severe renal insufficiency, the do sage of parenterally administered antibiotics (clinda mycin) should also have been reduced to avoid possible ad verse effects due to drug accumulation . As mentioned in our prescribing information, a few cases of agranulocytosis have been reported in cimetidine-treated patient s (the actu al numbers are approx ima tely 3/1000000). The se patients had generally serious concomitant illnesses, and were receiving drugs or treatment able to produce neutropenia. As Feston state s, \" there appears to be no basis for concluding that cimetidine causes granulocytopenia in patients with uncomplicated acid-peptic disease (the indicat ion for prescribing the drug in the vast majority of patients). In the few complex medical situations in which granulocytopenia has been reported, the role of cimet idine as opposed to that of underlying disease states and other drugs remains uncertain.\" 1 In the case reported by Dr Crapper, severe renal failure, septicaem ia, and the high intravenous dosage of c1indamycin may all have been involved in the occurrence of blood dyscrasia.
126 citations
TL;DR: The duration of low back pain symptoms was significantly shorter for subjects receiving mobilisation and manipulation; they also achieved symptom‐free status with fewer treatment sessions.
Abstract: In a controlled clinical trial, we allocated 48 subjects with acute low back pain but without neurological signs, at random to two treatment groups. The conservative treatments compared were passive mobilisation and manipulation of the lumbar spine and a regimen of microwave diathermy, isometric abdominal exercises and ergonomic instructions. The duration of low back pain symptoms was significantly shorter for subjects receiving mobilisation and manipulation; they also achieved symptom-free status with fewer treatment sessions. While the duration of symptoms before first treatment, the treatment administered, and the pretest forward flexion movement indices accounted for 44% of the variance in the duration of symptoms, a stepwise multiple regression analysis showed that treatment is the most significant factor in predicting the length of time before a subject achieves symptom-free status.
109 citations
TL;DR: The characteristic clinical and laboratory features of Lyme arthritis in a patient resident in the Hunter Valley are diagnosed and the epidemiological implications are discussed.
Abstract: We diagnosed the characteristic clinical and laboratory features of Lyme arthritis in a patient resident in the Hunter Valley. This paper discusses the epidemiological implications.
76 citations
TL;DR: Four workers from a recently established vanadium pentoxide refinery in Western Australia presented with green discoloration of the tongue, upper respiratory symptoms, and asthma, and two with most recent exposure to vanadium compounds exhibited bronchial hyperreactivity to histamine.
Abstract: Four workers from a recently established vanadium pentoxide refinery in Western Australia presented with green discoloration of the tongue, upper respiratory symptoms, and asthma. Three of them were non-atopic as judged by history, prick skin test responses, and total serum IgE levels. The two with most recent exposure to vanadium compounds exhibited bronchial hyperreactivity to histamine. Vanadium compounds appear to be capable of inducing asthma in previously normal subjects. One subject continued to wheeze eight weeks after this last exposure.
70 citations
TL;DR: A large, continuing outbreak of infection and colonisation with a Staphylococcus aureus which is resistant to methicillin and gentamicin is reported and it is suggested that a special isolation unit is needed.
Abstract: A large, continuing outbreak of infection and colonisation with a Staphylococcus aureus which is resistant to methicillin and gentamicin is reported. Affected patients and staff members seen between September, 1980, and August, 1981, are reviewed in detail. Methods of management of such persons and their treatment, if required, are discussed. The antibiotic-resistant Staph. aureus is readily disseminated in hospitals and may cause outbreaks of infection in wards, which require isolation of affected patients in the attempt to control the problem. It is suggested that a special isolation unit is needed. Use of the few effective antibiotic agents should be restricted. Despite these measures, the spread of this organism may not be contained.
59 citations
Journal Article•
TL;DR: A high degree of linear correlation between stated alcohol consumption and blood pressure, diastolic and systolic, was found, independent of age, adiposity and smoking.
Abstract: We studied the association between stated alcohol consumption and blood pressure, making allowance for age, adiposity and smoking in 13535 men and 7385 women who were not receiving antihypertensive treatment. They represented a wide cross-section of the inner Sydney working population with 95% aged between 18 and 70. We found a high degree of linear correlation between stated alcohol consumption and blood pressure, diastolic and systolic. This relationship was independent of age, adiposity and smoking. For each 100 g/week increase in stated alcohol consumption, diastolic blood pressure increased by 0.12 kPa (0.92 mmHg) in men and by 0.20 kPa (1.5 mmHg) in women; no threshold for this effect was evident. A plateau appeared at about 500 g/week. Blood pressure increased significantly with age and adiposity (Quetelet's index). Smoking was associated with a lower diastolic blood pressure. The difference in mean diastolic blood pressure between smokers and non-smokers was 0.20 kPa (1.5 mmHg) for men and 0.27 kPa (2.1 mmHg) for women.
56 citations
TL;DR: There seems, then, to be no deficiency in serum TBG concentration in these two groups of native people living in Papua New Guinea such as has been described in Australian Aborigines.
Abstract: Each Percodan tablet contains Oxycodone Hel 4.83mg. aspirin 224 mg and paracetamoll60 mg. Aborigines.': 2 This trait, which appears to be controlled by an autosomal gene, may lead to misdiagnosis of hypothyroidism in Aborigines. The low TBG levels in the Aborigines appear from the evidence to be geographically widespread and to reach a prevalence as high as 40% of the Aboriginal population in some areas. The finding raises the question of similar anomalies being present in other ethnic groups. Therefore, when we recently had access to serum specimens from Papua New Guinean subjects, we assayed TBG using an \"in-house\" radioimmunoassay and performed routine thyroid function tests. Sixty-six specimens were available from subjects with a wide range ofages. Fifty-one came from inhabitants living in a mountainous area. and 15 from age and sex-matched controls living in coastal areas. None of the subjects was pregnant or taking any medication known to affect TBG levels. The mean TBG concentration for both groups combined was 24.3 ±9.7 mg/L, which represented a 95% reference range of 15-34, and there was no significant difference between the two groups. This result compares with the reference range of 12-29 obtained in normal volunteer subjects in Adelaide. No significant abnormalities were found in serum thyroxine or triiodothyronine concentrations compared with the Adelaide reference ranges. The serum TSH appeared very marginally elevated (2.9 ±3.8 m units/rnl.) in relation to the Adelaide reference range ( < 3). This is due to mild elevations in a few of the subjects living in the mountainous region and is probably secondary to some degree of iodine deficiency. The TBG values confirm those obtained in an earlier study based on an older technique;' in: which it was also demonstrated that native women, living in an area of high prevalence of endemic cretinism, had normal TBG increases in pregnancy. There seems, then, to be no deficiency in serum TBG concentration in these two groups of native people living in Papua New Guinea such as has been described in Australian Aborigines.
54 citations
TL;DR: The internal cohesion of the data analyses, and the plausibility conferred by experimental evidence, suggests that the underground water, and its elevated concentration of nitrates, may warrant further consideration as a source of human teratogens.
Abstract: We report a descriptive study indicating a localised excess of congenital malformations in Mount Gambier, South Australia, and summary results of a subsequent case-control study showing an association between the occurrence of congenital malformations and the consumption of underground water by pregnant women. The internal cohesion of the data analyses, and the plausibility conferred by experimental evidence, suggests that the underground water, and its elevated concentration of nitrates, may warrant further consideration as a source of human teratogens.
TL;DR: An initial assessment of families with children conceived by artificial insemination with donor semen (AID) concluded that no major obstetric, paediatric, or emotional problems were apparent.
Abstract: To provide an initial assessment of families with children conceived by artificial insemination with donor semen (AID), 50 couples were interviewed when the children were between one and three years of age. Information was obtained about the obstetric outcome, child development, and the couples' reaction to AID. It was concluded that no major obstetric, paediatric, or emotional problems were apparent.
TL;DR: It was not always possible to discriminate heterozygotes from normal controls by enzyme assay of leucocyte or fibroblast homogenates in this study of a large number of mucopolysaccharidoses Type II by means of a single hair root assay system.
Abstract: We assessed lysosomal exohydrolase activities in homogenates of cultured skin fibroblasts and peripheral blood leucocytes of approximately 550 patients referred from throughout Australasia and suspected of having a mucopolysaccharidosis. Of these, 96 patients from 80 families were diagnosed as being homozygous deficient for a particular lysosomal enzyme activity. Clinical phenotype varied considerably within each of the enzyme-deficient states. This did not correlate with the level of "residual" enzyme activity in leucocyte or fibroblast homogenates. It was not always possible to discriminate heterozygotes from normal controls by enzyme assay of leucocyte or fibroblast homogenates in this study of a large number of mucopolysaccharidoses Type II by means of a single hair root assay system.
Journal Article•
TL;DR: Analysis of patterns of male mortality in Australia during 1968-1978 shows elevated death rates from liver cirrhosis, alcoholism and alcoholic psychosis in various rural, service, and "blue-collar" occupations.
Abstract: Analysis of patterns of male mortality in Australia during 1968-1978 shows elevated death rates from liver cirrhosis, alcoholism and alcoholic psychosis in various rural, service, and "blue-collar" occupations. The risks of mortality from lung cancer and cancers of the upper alimentary tract and larynx--sites influenced by alcohol and tobacco consumption--are raised in the latter two groups. In contrast, the risks of mortality from cancer of the colon, thought to be influenced by dietary "affluence", are consistently higher for professional and "white-collar" groups. As reported in other populations, stomach cancer mortality risks are higher for service and blue-collar groups. The risks of mortality from coronary heart disease and cerebrovascular disease are also higher, albeit moderately, for these two groups. The consideration of personal behaviour as a reflection of socioeconomic and subcultural influences is a prerequisite to effective community health education.
TL;DR: Patients with staphylococcal diarrhoea present a significant crossinfection risk, and early diagnosis, treatment, and isolation are essential.
Abstract: Methicillin-resistant Staphylococcus aureus was thought to be the cause of 10 cases of antibiotic-associated diarrhoea observed over a 12-month period at The Royal Melbourne Hospital. Each patient had significant underlying disease, and all had been treated with multiple, broad-spectrum antibiotic agents. The diagnosis was made on the distinctive Gram-stain appearance of faecal smears, the heavy predominant growth of methicillin-resistant Staph. aureus from stool cultures, and the absence of other bowel pathogens, including toxigenic Clostridium difficile. Diarrhoea usually responded to treatment with vancomycin or bacitracin, and, in patients whose condition improved, the stools cleared of staphylococci. Patients with staphylococcal diarrhoea present a significant crossinfection risk, and early diagnosis, treatment, and isolation are essential.
TL;DR: This study examined the relapse rate of 194 people who were given acupuncture treatment to help them stop smoking and found that acupuncture had eased the symptoms of smoking withdrawal.
Abstract: Nicotine addiction makes it very difficult for most smokers to quit. This study examined the relapse rate of 194 people (118 men and 76 women) who were given acupuncture treatment to help them stop smoking. Ninety five per cent of patients quit smoking after three acupuncture treatments. Fifty-five (32%) of the 174 patients who replied to a mailed questionnaire said they had not smoked since treatment; the success rate was: one week, 86%; six months 41%; 12 months, 34% and 24 months, 30%. There were no further relapses amongst those patients who abstained for more than 24 months. Eighty-five per cent of those who responded reported that acupuncture had eased the symptoms of smoking withdrawal. However, if the patient's motivation is weak, subsequent relapse will occur.
TL;DR: The mean length of stay of 8.6 days suggests geriatric assessment units are an efficient and effective method of meeting the health care needs of the hospitalised elderly patient.
Abstract: Few Australian teaching hospitals provide designated ward areas for the direct admission of acute and chronically ill elderly patients. A 14‐bed geriatric assessment unit was recently set up at the Flinders Medical Centre in South Australia, and we examined the pattern of medical illness in the first 100 patients (75 years and over) admitted to the unit. Of concern was the high incidence of drug induced illness (31%) in those entering the unit. The mean length of stay of 8.6 days suggests such units are an efficient and effective method of meeting the health care needs of the hospitalised elderly patient.
TL;DR: Strains of MRSA obtained from Australian hospitals in 1981 resembled MRSA from other countries and were probably derived from them; in particular, they did not survive desiccation better than other staphylococci and produced lipases which might be responsible for their invasiveness.
Abstract: Seventy-eight cultures of multiresistant Staphylococcus aureus (MRSA), obtained from Australian hospitals in 1981, were studied to see whether they possessed novel properties responsible for their epidemic spread. In general, these strains resembled MRSA from other countries and were probably derived from them; in particular, they did not survive desiccation better than other staphylococci. The majority of MRSA produced lipases, which might be responsible for their invasiveness, and all produced high amounts of beta-lactamase which hydrolysed each of the isoxazolyl penicillins. This may account for therapeutic failure with cloxacillin of flucloxacillin. Control of this epidemic should rely principally on general measures against the hospital staphylococcus.
TL;DR: The data do not support the view that there is wide‐spread hearing loss caused by exposure to amplified music in young people under the age of 21 years, but the accumulated exposure of some of them to noise is such that, if their recreational patterns remain the same, they are at risk of some noise‐induced hearing loss by their mid‐twenties.
Abstract: We gave 944 young people (aged 16 to 20 years) pure-tone audiometry, electroacoustic impedance tests, and ear, nose and throat examination. We questioned them about their histories of exposure to occupational and recreational noise. The data do not support the view that there is wide-spread hearing loss caused by exposure to amplified music in young people under the age of 21 years. However, the accumulated exposure of some of them to noise is such that, if their recreational patterns remain the same, they are at risk of some noise-induced hearing loss by their mid-twenties. Further empirical studies are necessary to determine whether these hearing losses will eventuate.
TL;DR: Analysis of patterns of male mortality in Australia during 1968‐1978 shows elevated death rates from liver cirrhosis, alcoholism and alcoholic psychosis in various rural, service, and “blue‐collar” occupations.
Abstract: Analysis of patterns of male mortality in Australia during 1968‐1978 shows elevated death rates from liver cirrhosis, alcoholism and alcoholic psychosis in various rural, service, and “blue‐collar” occupations. The risks of mortality from lung cancer and cancers of the upper alimentary tract and larynx —sites influenced by alcohol and tobacco consump‐tion—are raised in the latter two groups. In contrast, the risks of mortality from cancer of the colon, thought to be influenced by dietary “affluence”, are consistently higher for professional and “white‐ collar” groups. As reported in other populations, stomach cancer mortality risks are higher for service and blue‐collar groups. The risks of mortality from coronary heart disease and cerebrovascular disease are also higher, albeit moderately, for these two groups. The consideration of personal behaviour as a reflection of socioeconomic and subcultural influences is a prerequisite to effective community health education.
Journal Article•
TL;DR: A survey of children born between 1949 and 1980 who are known to have been fitted with hearing aids in Australia by the age of 18 years reveals a ratio of 2.605 cases for every 1000 liver births that indicates the incidence of childhood deafness is higher than previously reported.
Abstract: A survey of children born between 1949 and 1980 who are known to have been fitted with hearing aids in Australia by the age of 18 years reveals a ratio of 2.605 cases for every 1000 liver births. This incidence of childhood deafness is higher than previously reported, as a result of the greater number of birth years considered. Approximately 41.2% of these children have severe or profound deafness. A history of maternal rubella was reported in 11.06% of cases, but a significant reduction in the number of reported rubella cases after 1976 has led to correspondingly fewer diagnoses of severely and profoundly deaf children.
TL;DR: A study of 400 Sydney children of preschool age has found a range of blood lead levels from 0.1 μmol/L to 1.4 μ mol/L, with no children having readings above the currently accepted “level of concern”.
Abstract: A study of 400 Sydney children of preschool age has found a range of blood lead levels from 0.1 mumol/L to 1.4 mumol/L (2 micrograms/100 mL to 29 micrograms/100 mL), with no children having readings above the currently accepted "level of concern". Within the Sydney metropolitan area, a significant inverse relationship was found between blood lead level and distance of the home from the city centre. Within the range of blood lead levels, no relationship appeared between blood lead levels and performance in verbal intelligence test, three of the tests of motor ability, and a parent rating. In one of the tests of fine motor coordination, there was a tendency for the children with lower lead levels to perform better than those with moderate blood lead levels. In one of the tests of gross motor skill, the results for the two age groups were conflicting. Further studies of a prospective nature covering the period of maximum vulnerability (0 to three years) are essential before any conclusion can be drawn about the effects of subclinical blood levels of lead.
TL;DR: Five cases of fatal paraquat poisoning after skin absorption in adult Papua New Guinea men, three of which had marked blistering and excoriation, and all died from respiratory failure.
Abstract: This paper reports five cases of fatal paraquat poisoning after skin absorption in adult Papua New Guinea men. Three incidents followed occupational accidents, one victim used paraquat concentrate to treat a scabies infestation, and one used it to treat head lice. All had marked blistering and excoriation, and all died from respiratory failure. In developing countries, reporting on poisoning incidents is very limited, and treatment of paraquat poisoning is, for practical purposes, nonexistent. As paraquat is not essential for tropical agriculture, its continued use should be critically reviewed. Language: en
TL;DR: The hypothesis that pedal cyclists are subject to significantly greater risk of head injury than motorcyclists, who are required by law to wear crash helmets is tested.
Abstract: There being no legal requirement in Victoria for pedal cyclists to wear crash helmets (and only few do so), we tested the hypothesis that pedal cyclists are subject to significantly greater risk of head injury than motorcyclists, who are required by law to wear them. Injury data of 1975 to 1980 showed that there were three times more fatalities and reported non-fatal casualities among motorcyclists than among pedal cyclists. Head injuries, including fractured vault of skull, fractured base of skull, concussion and intracranial injury, were significantly more frequent among pedal cyclist casualties (P less than 0.001). The number of pedal cyclist casualties with solely head injury was twice that of motorcycle riders, and those pedal cyclist casualties had a significantly greater incidence of fractured vault of the skull. It is likely that risk of head injury for pedal cyclists would be significantly reduced if they wore protective helmets.
TL;DR: A high degree of linear correlation between stated alcohol consumption and blood pressure, diastolic and systolic, was found, independent of age, adiposity and smoking.
Abstract: We studied the association between stated alcohol consumption and blood pressure, making allowance for age, adiposity and smoking in 13 535 men and 7385 women who were not receiving antihypertensive treatment. They represented a wide cross‐section of the inner Sydney working population with 95% aged between 18 and 70. We found a high degree of linear correlation between stated alcohol consumption and blood pressure, diastolic and systolic. This relationship was independent of age, adiposity and smoking. For each 100 g/week increase in stated alcohol consumption, diastolic blood pressure increased by 0.12 kPa (0.92 mmHg) in men and by 0.20 kPa (1.5 mmHg) in women; no threshold for this effect was evident. A plateau appeared at about 500 g/week. Blood pressure increased significantly with age and adiposity (Quetelet's index). Smoking was associated with a lower diastolic blood pressure. The difference in mean diastolic blood pressure between smokers and non‐smokers was 0.20 kPa (1.5 mmHg) for men and 0.27 kPa (2.1 mmHg) for women.
TL;DR: A case of haemorrhagic cystitis caused by adenovirus type 11, which occurred in a female patient 13 weeks after renal transplanta‐tion is described, and the data suggest that the infection was transmitted by the kidney graft.
Abstract: A case of haemorrhagic cystitis caused by adenovirus type 11, which occurred in a female patient 13 weeks after renal transplantation is described. The patient lacked neutralising antibody to adenovirus type 11 before transplantation, but this antibody was present in the serum of the kidney donor. The patient developed antibody to adenovirus type 11, and this virus was isolated from her throat and urine. The data suggest that the infection was transmitted by the kidney graft.