Disorders of movement and behaviour during sleep.

Objective: To outline recently described movement disorders during sleep which are common and poorly recognised.

Data Sources: Computer-based literature search up to July 1990 (with the index terms sleep disorders, sleep myoclonus, nocturnal myoclonus, periodic movements in sleep, REM behaviour disorder and parasomnias) supplemented by a manual search through the references of papers obtained by computer search and a manual search through contents of the following journals: Sleep, Sleep Research, Neurology and Brain.

Data Synthesis And Conclusion: There is a group of common and poorly recognised movement disorders during sleep.

Recent trends in the prescribing of cholesterol lowering drugs in Australia. A report from the Drug Utilization Subcommittee of the Pharmaceutical Benefits Advisory Committee.

Objective: To determine the recent pattern of use of hypolipidaemic drugs in the Australian community.

Design: Drug utilisation study employing prescription data collected during the operation of the Australian Pharmaceutical Benefits Scheme (PBS).

Setting: Non-hospital drug use in Australia.

Failure to demonstrate contrast nephrotoxicity.

Objective: We tested the hypothesis that there is no difference in the change in serum creatinine level following computed tomography (CT) between those given high osmolality contrast, low osmolality contrast and those not receiving contrast material.

Design: Patients were assigned according to current radiological practice to receive one or other type of radiocontrast material or to have a scan without intravenous contrast (plain scan).

Setting: The CT unit of Royal Newcastle Hospital, a tertiary referral institution.

Acute pancreatitis and rhabdomyolysis: a new association.

Fourteen cases of acute severe pancreatitis complicated by non-traumatic rhabdomyolysis are described and compared to case controls. Pancreatitis of various aetiologies was confirmed by surgical diagnosis, laparotomy, abdominal paracentesis, CAT scan and post mortem. Pancreatitis was severe with a high Ranson prognostic score (7.

Brachiobasilic fistula with autogenous basilic vein: surgical technique and pilot study.

This pilot study examined the efficacy of the brachiobasilic fistula formed by a loop of autogenous basilic vein in 15 consecutive patients requiring secondary access. The technique of its construction is also described. The fistula survival at 1 year was 70% and at 2 years was 50%.

The accessory soleus muscle: a case report and review of the literature.

A case of histologically proven accessory soleus muscle simulating a soft tissue tumour in a young male is reported. The radiological features are demonstrated and reviewed.

Passive smoking and the risk of heart attack or coronary death.

Objectives: To estimate the prevalence of passive smoking in an Australian population, the magnitude of risk of myocardial infarction or coronary death associated with passive smoking and the extent to which fibrinogen concentrations might be affected by passive smoking.

Design: A population-based case-control study of myocardial infarction or coronary death and passive smoking, and measurement of fibrinogen in a random sample from the same population.

Setting And Participants: Residents of the Lower Hunter Region of New South Wales aged 35-69 years in 1988-1989.

The safety and cost-effectiveness of low osmolar contrast media. Can economic analysis determine the real worth of a new technology?

Objectives: To estimate the reduction in mortality associated with a reduced adverse reaction rate following the substitution of older high osmolar radiocontrast media (HOCM) by the newer and more expensive low osmolar contrast media (LOCM), and to assess the cost-effectiveness of switching from HOCM to LOCM in patients with and without underlying risk factors for adverse reactions from radiocontrast agents.

Data Sources: Data from large prospective studies of adverse reactions to HOCM and LOCM were used to estimate the expected number of deaths and severe non-fatal reactions in a hypothetical population receiving one million intravenous radiocontrast injections with HOCM, and the expected reduction in the frequency of these outcomes after substitution by LOCM in high-risk and low-risk groups respectively. Life-years lost with each radiocontrast-related death were estimated from an audit of fatal adverse reaction reports submitted to the Adverse Drug Reactions Advisory Committee.

Common skin infections.

A variety of skin infections is seen in general practice. Because the diagnosis can often be made clinically, therapy can be initiated before laboratory results are obtained. Some of the common skin infections are discussed in this article.

Atypical case of Pott's disease.

An unusual case of Pott's Disease in an adult, Australian born, caucasian male is reported. The typical and atypical radiological features of spinal tuberculosis are reviewed.

Long-term nasal CPAP does not ameliorate obstructive sleep apnoea.

Fifty-seven patients with obstructive sleep apnoea (OSA) were treated for at least six months with nasal continuous positive airway pressure (CPAP). At follow-up, sleep studies were performed in which CPAP was not used for the first half of the night. We compared the severity of OSA at follow-up without CPAP to the severity of OSA during the patient's initial diagnostic study.

Nodal involvement in poorly differentiated breast cancer.

The degree of nodal involvement in a consecutive series of 400 patients with invasive ductal breast cancer is presented. A positive correlation was observed between the number of metastatic nodes identified and the number of axillary nodes examined for poorly but not moderately differentiated tumours. The relevance of this observation to breast cancer trials is discussed.

Use of the fistula assessment monitor to detect stenoses in access fistulae.

Twenty-three unselected hemodialysis patients with functioning access arteriovenous fistulae were studied prospectively to determine the best technique for detecting stenoses within the fistulae. Combined clinical assessment and fistula assessment monitoring were compared with transbrachial angiography. Fistula assessment monitoring was more accurate (96%) than combined clinical assessment (accuracy, 52%) in stenosis detection.

Ketamine, midazolam and vecuronium infusion. Anaesthesia for Down's syndrome and congenital heart disease.

A ketamine, midazolam and vecuronium infusion was used for total intravenous anesthesia in a patient with Down's syndrome, a ventricular septal defect and pulmonary hypertension. A mixture of ketamine 200 mg, midazolam 5 mg and vecuronium 12 mg in 50 ml of normal saline was infused at 0.5 ml/kg/hour.

Treatment Results in Adolescent and Adult Acute Lymphoblastic Leukaemia Using a Uniform Chemotherapy Protocol.

Fifty-four adolescent and adult patients with newly-diagnosed acute lymphoblastic leukaemia (ALL) were treated with combination chemotherapy at three Australian hospitals. The protocol consisted of one month of induction therapy with five cytotoxic agents, followed by consolidation therapy and prophylactic treatment to the central nervous system, then maintenance chemotherapy for 30 months on an outpatient basis. Complete remission was achieved in 47 (87%) patients, with 5 deaths due to treatment-related toxicity.

Detoxification: the basis of current practice.

With chronic use of a psychoactive drug the central nervous system undergoes a series of changes. These changes vary both in nature and in extent with each drug, but in general, they alter the responsiveness of the nervous system to the drug so as to reduce the perceived clinical effect, and also alter the innate responsiveness of the affected neurons to various stimuli. With cessation of drug use the nervous system undergoes a natural healing which consists of a restoration of normal responsiveness, but this process takes some time during which the patient's responses are abnormal and they are vulnerable to a variety of stressors.

Drug withdrawal: a selective review.

This review will concentrate on the contributions medical science, in particular pharmacology and electrophysiology, have made to the understanding of withdrawal states and so will look mostly at the first element in withdrawal. Behavioural and emotional issues will be dealt with in the section on management.

Acute renal failure due to acute pyelonephritis.

We report a case of biopsy-proved acute pyelonephritis which caused acute renal failure. Despite appropriate antibiotic therapy, recovery of renal function was slow and incomplete. Renal papillary necrosis was an apparent complication, which the patient may have been predisposed to by alcoholism.

How soon after quitting smoking does risk of heart attack decline?

A population-based case-control study (involving 1282 cases and 2068 controls) was conducted to examine the risk of myocardial infarction or coronary death after cigarette smokers quit smoking. The odds ratios for current smokers were significantly elevated compared to non-smokers (OR = 2.7 for men and OR = 4.

Peri-operative care for oesophagectomy patients.

The aim of this study was to evaluate factors relevant to morbidity and mortality in 54 patients undergoing oesophagectomy at Royal Newcastle Hospital between 1985 and March 1989. There was a high incidence of concurrent medical problems. Significant anaesthetic complications occurred in 6 patients.

Patterns of use of chest physiotherapy in a teaching hospital.

Studies of chest physiotherapy in medical patients have consistently shown benefit only in patients who produce large amounts of sputum. Among surgical patients systematically repeated maximal inspiration is the only procedure that clearly reduces the incidence of post-operative pulmonary complications. Rationalization of the use of physiotherapy requires data on the pattern of its use.

Reduction of complications associated with total parenteral nutrition by introduction of a clinical monitoring team. The Total Parenteral Nutrition Committee.

The introduction of Total Parenteral Nutrition (TPN) in the treatment of malnourished patients with unusable gastrointestinal tracts has become commonplace throughout the world. However there are significant metabolic (4.2 to 7.