Sonographically detected caesarean section scar defects and menstrual irregularity.

The purpose of this study was to estimate the frequency of post-caesarean section scar defects (PCSD) on transvaginal ultrasound and to correlate these with the presence of abnormal menstrual bleeding. We reviewed the pelvic ultrasound images of 318 women referred for a gynaecological scan in a private women's ultrasound clinic. The incidence of defects at the expected location of a caesarean scar was evaluated and then correlated with patient responses to a questionnaire on abnormal menstrual bleeding.

Recurrent viable ectopic pregnancy in the salpingectomy stump.

Ipsilateral ectopic pregnancy after total salpingectomy is a rare occurrence and in theory should not happen. We report a case where a spontaneous ectopic pregnancy was found in the stump of the previously removed tube. This case highlights the need for further consideration of the diagnosis of an ectopic pregnancy in the setting of a previous ipsilateral salpingectomy.

Absent fetal hand: a case report.

Isolated congenital fetal hand malformation is a rare finding. The prevalence of limb reduction deformities is about 3-8 per 20,000 births. An isolated amputation of an extremity can be due to amniotic band syndrome, exposure to a teratogen or a vascular accident.

The conflict between the ethics of th individual and the ethics governing public health: practical sustainability of health care in jeopardy?

The "health rights movement" has reconstructed the clinical relationship between health care workers and patients by simultaneously demanding more from traditional medical care and challenging the perceived power differential between doctors and patients by rejecting the paternalistic medical model in favour of an individual patients' rights model. However, the growth in individual expectations of a right to health care creates a potential conflict with the ethics that prioritise public health and guide the rationing of its limited financial and human capital resources. This, in turn, creates a practical dilemma which requires public health institutions to become service orientated while sacrificing their integral role in training and educating the medical workforce and potentially compromising the practical sustainable delivery of public health in Australia.

The impact of education and experience on death anxiety in new graduate nurses.

Anecdotal evidence suggests that new graduate nurses are ill prepared for their experiences with death. This study explores death anxiety and coping skills in registered nurses during their first year of practice. Participating nurses were undertaking a transition support program; the subject group attended a Death Issues Workshop while the control group did not receive any formal education on death issues during their program.

Proton pump inhibitors and acute interstitial nephritis.

Background & Aims: Proton pump inhibitors (PPIs) are a widely prescribed class of drugs, and their usage worldwide is increasing. Although well-tolerated, there have been case reports and a recent case series implicating these drugs in acute interstitial nephritis (AIN) and progression to acute renal failure (ARF). The aim of this study was to investigate how widespread this complication is in Australia, to identify which PPIs are implicated, and to establish whether PPI-induced AIN is a class effect.

Race, culture and psychiatry: a history of transcultural psychiatry.

The term 'transcultural psychiatry' has encompassed changing notions of race, culture and psychiatry and, as a result, it is a difficult concept to define. For a long time psychiatrists and social scientists have been commenting on how the psyches and psychiatric illnesses differ in non-White populations. However, transcultural psychiatry was not created as a distinct discipline until after World War II.

Post-hyperventilation hypoxaemia is due to alteration of ventilation and perfusion matching.

Objective: The aim of this study was to investigate the mechanisms of post-hyperventilation hypoxia.

Methodology: Seven healthy male volunteers, aged 29.1 +/- 1.

Lignocaine toxicity; a complication of local anaesthesia administered in the community.

Local anaesthetic agents are among the most commonly used drugs in the emergency department. A case is reported of a complication arising from systemic toxicity after the injection of lignocaine (lidocaine). Emergency practitioners should maintain a high level of vigilance for the symptoms of toxicity after local anaesthetic administration.

Increased lung water without hypocapnia does not cause central sleep apnoea in a lamb model.

Objective: Central sleep apnoea (CSA) in patients with heart failure is associated with an extremely poor prognosis. It is unclear as to whether pulmonary congestion contributes to CSA.

Methodology: We developed a sheep model of congestive cardiac failure (CCF) to address the question of whether pulmonary congestion without hypocapnia could cause CSA.

A comparison of the sports safety policies and practices of community sports clubs during training and competition in northern Sydney, Australia.

Objectives: To compare the safety policies and practices reported to be adopted during training and competition by community sports clubs in northern Sydney, Australia.

Methods: This cross sectional study involved face to face interviews, using an 81 item extensively validated questionnaire, with representatives of 163 community netball, rugby league, rugby union, and soccer clubs (response rate 85%). The study was undertaken during the winter sports season of 2000.

Antidepressants for treating depression in dementia.

The use of antidepressants for patients with dementia accompanied by depressive symptoms is widespread, but their clinical efficacy is uncertain. Many of the individual trials of antidepressants have been too small to provide precise estimates of the moderate benefits that might realistically be expected. Combining the information from all appropriate trials may provide a better estimate of the likely effects of treatment.

Tourniquet-induced restriction of the quadriceps muscle mechanism. Fact or fiction?

Many knee surgeons flex the knee and sometimes also extend the hip before inflating a tourniquet on the thigh. This practice stems from the belief that these manoeuvres prevent excessive strain on the quadriceps during surgery, the assumption being that movement of the muscle is restricted by an inflated tourniquet. We therefore examined, using ultrasound, the movement of the quadriceps muscle above and below the tourniquet before and after inflation.

Spirometry values in Himalayan high altitude residents (Sherpas).

We compared the spirometric values of the isolated racial group of Himalayan Sherpas with those predicted for the European Coal and Steel Community (EC&S). 146 normal adult Sherpas (64 males, 82 females) and 103 adolescents (37 females and 66 males, age 10-18 years) resident at an altitude of 3,840 m were studied. Predicted values for each adult individual were calculated using the EC&S reference equations and separate Caucasian values for children were used, and new predictive equations for the Sherpa population derived.

Use of complementary therapies in a sexual health clinic setting.

This prospective cohort study examined the health-seeking behaviour of patients diagnosed with genital warts and vulvodynia who presented to Manly Sexual Health Service from March to June 2000. A self-administered questionnaire was used to assess patients' perceptions of their condition and their use of complementary therapies. Thirty-seven patients with genital warts and 26 patients with vulvodynia participated in the study.

Spontaneous echo contrast: where there's smoke there's fire.

Left atrial (LA) spontaneous echo contrast (SEC), or "smoke," is a frequent finding on transesophageal echocardiography (TEE), but it is rarely detected with transthoracic echocardiography. LA SEC is characterized by dynamic smoke-like echoes within the LA cavity or appendage. Most patients with LA SEC have atrial arrhythmias, mitral stenosis, or a mitral valve prosthesis, and they have an enlarged LA, conditions that are associated with LA stasis.

Persistent, progressive hypophosphataemia after voluntary hyperventilation.

Hyperventilation (HV) and respiratory alkalosis are associated with hypophosphataemia, although the extent and duration of HV required to produce changes in serum phosphate levels are not known. We sought to characterize the effects of HV, with or without dextrose loading, on serum phosphate levels and other biochemical parameters. HV was monitored by controlling the end-tidal partial pressure of carbon dioxide (PETCO(2)).

Factors associated with participation in resident action groups in metropolitan Sydney: a cross-sectional survey.

Objective: To explore the characteristics of participants in resident action groups in metropolitan Sydney.

Methods: A stratified random sample of participants in 50 groups registered with local councils were surveyed in 1997. Demographic, social/psychological, cost/benefit, group process and group potency variables and four measures of amount of participation were examined.

Functional status and health service planning.

Functional status indicators have been proposed as instruments to aid health service planning for patients. This study examines functional status at three points surrounding an acute health episode: admission, discharge and 3 months post discharge from a community hospital. The aim of the study is to determine the most appropriate time to measure functional status to assist health service planning.