A rare case of adult-onset Still's disease presenting in the early postpartum period.

The interplay of pregnancy, the immune system and its impact on autoimmune disease is an area of growing interest. Adult-onset Still's disease is a rare auto-inflammatory disorder characterised by fever, rash, arthralgia and leucocytosis. We describe a rare case of the disease presenting for the first time in the immediate postpartum period, highlighting pregnancy and birth as possible triggers for this condition.

Severe tachypnoea and dyspnoea due to physiological hyperventilation in pregnancy.

Physiological hyperventilation and dyspnoea in pregnancy are well-established phenomena and commonly lead to a chronic respiratory alkalosis with compensatory renal excretion of bicarbonate. However, the underlying mechanism of dyspnoea during normal pregnancy remains largely undefined. Increasing progesterone levels are a primary factor leading to increased respiratory drive to ensure the rising metabolic demands of the pregnancy are met.

Regional Victoria physician subspecialty training and workforce: the current state of play.

This report outlines the advantages and barriers to working and training in regional Victoria with an aim to provide future researchers with data points to address the maldistribution of medical specialists in regional Australia. Some of the advantages are positive job satisfaction, collegiality and good work-life balance, while increased workload and insufficient number of specialists were reported as disadvantages.

Could uric acid have a pathogenic role in pre-eclampsia?

Interest has been renewed over the role of uric acid in the pathogenesis of hypertension, endothelial dysfunction and renal dysfunction, which are all features of pre-eclampsia. Uric acid is not a consistent predictive factor for the development of pre-eclampsia but its levels generally increase once the disease manifests, and plasma levels of uric acid approximately correlate with disease severity. Hyperuricemia in pre-eclampsia was once thought to result solely from reduced renal clearance, but levels of uric acid are now also thought to increase through increased uric acid production caused by trophoblast breakdown, cytokine release and ischemia.

Paraneoplastic mononeuritis multiplex in non-small-cell lung carcinoma.

A 60-year-old man developed two selective peripheral mononeuropathies of the peroneal and later the radial nerve, shortly after a diagnosis of large-cell lung carcinoma. Nerve conduction studies and electromyography confirmed isolated lesions in both nerves, and in the case of the peroneal nerve lesion, focal conduction block was localised to the level of the fibula neck. Subsequent magnetic resonance imaging of the lower limb excluded focal compression or malignant infiltration along the course of the peroneal nerve, and there was no signal change within the nerve, prompting a diagnosis of paraneoplastic mononeuritis multiplex.