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To review general practitioner (GP) implementation of evidence based cardiovascular risk reducing strategies in subjects with coronary heart disease (CHD).Audit of patient records of randomly selected GPs.There were 326 subjects with CHD under the care of 21 doctors. Except for smoking, details of lifestyle measures were rarely found in the notes. Advice on diet and exercise was mentioned in 51% and 23.3% of records respectively. Aspirin and beta-blockers were widely used. Of patients with drug untreated values of total cholesterol (TC) and/or TC/HDL exceeding National Heart Foundation (NHF) guidelines, 71% were prescribed lipid-modifying drugs. NHF targets for TC (or = 5.0 mmol/l) were achieved by 37% and for TC/HDL (or = 4.5) by 60%. TC remained above 5.5 mmol/L in 120 cases. Lipid results from tests within the last 12 months were found in 60% of cases.Recording of lifestyle treatments in subjects with CHD appears to be assigned low priority. Cardioprotective treatments were widely used. Cholesterol levels were recorded frequently and of those with values exceeding NHF guidelines, nearly 3/4 were on medication. Recommended targets for lipid parameters were being achieved by50% of patients. More frequent monitoring could improve this outcome

To determine the prevalence of hepatitis A (HAV), hepatitis B (HBV) and hepatitis C (HCV) in adults randomly selected from the Christchurch community.A list of names was randomly generated from the Christchurch electoral roll and subjects were sequentially contacted and invited to participate. A blood sample was taken and tested for hepatitis A (IgG anti-HAV antibody), hepatitis B (HBsAg and anti-HBc) and HCV (anti-HCV antibody) using Abbott Elisa kits. Subjects positive for HBsAg were also tested for HBeAg/HBV DNA. Those positive for anti-HBc were tested for anti-HBs. HCV antibody positive samples were tested for HCV RNA using PCR.1064 subjects (30.3% of those invited) participated in the study. The prevalence of HAV antibodies was 27.9%, and increased with age. The overall prevalence of HBV markers was 42/1064 (4.2%), and of these 0.3% were HBsAg positive and 3.9% were considered immune. No gender or ethnic differences in these proportions were observed. The seroprevalence of HVC antibody was 3/1064 (0.3%), two of whom were also PCR positive for HCV RNA.In the Christchurch community there was a high prevalence of antibodies to HAV, which increased with age. The prevalence of HBsAg and antibody to HCV were both low at 0.3%.

To determine the frequency of HLA-H gene mutations in New Zealand patients with haemochromatosis.The Cys282Tyr and His63Asp mutations in the HLA-H gene were analyzed by polymerase chain reaction, restriction enzyme digestion and electrophoresis in two separate patient groups. The first was a group of 20 Christchurch patients with a definite clinical diagnosis of haemochromatosis. The second group consisted of 33 patients, with a provisional diagnosis of haemochromatosis, attending Dunedin Hospital for therapeutic venesection.All 20 Christchurch patients and 25 of the 33 (76%) Dunedin patients were homozygous for the Cys282Tyr mutation. After review of the clinical data, histology and response to venesection a diagnosis of haemochromatosis could be confidently excluded in six of the remaining eight patients. Despite atypical features, a diagnosis of haemochromatosis could not be excluded in the final two patients, one of whom was a compound heterozygote for the two mutations.Homozygosity for the Cys282Tyr mutation is closely associated with haemochromatosis in New Zealand patients. Molecular analysis of the HLA-H gene is indicated in the assessment of patients with iron overload including those currently being treated by venesection.

To develop and validate a test for the diagnosis of Huntington's disease by the direct detection, and sizing of, expanded CAG triplet repeats within the Huntington gene of affected individuals.A polymerase chain reaction-based test which specifically amplifies the CAG repeat was developed using an ultra heat stable polymerase and [alpha 35S] delta ATP incorporation. Amplified alleles were separated on DNA sequencing gels and sized by comparison with a known sequence.Analysis of 10 affected individuals showed abnormal alleles with repeat numbers ranging from 40 to 61. In one case, that had been diagnostically uncertain because there was no family history of Huntington's disease, the demonstration of an expanded allele confirmed the diagnosis. Analysis of this patient's elderly and unaffected father indicated that he had an allele at the extreme end of the normal range. In a second case with atypical neurological features the diagnosis was also established by the demonstration of an expanded allele.This assay allows improved diagnosis of Huntington's disease including completely accurate presymptomatic and antenatal diagnosis. Easy access to this test has implications for clinical practice but acceptable guidelines for its use will need to be developed.

Following detection of symptomatic lead toxicity in two users of an indoor small bore rifle range, we studied users of several similar facilities to determine if significant recreational lead exposure occurred.Red cell lead levels were measured at the end of a six month (winter) indoor shooting season and prior to commencement of shooting in the following year. Lead levels in air and dust sampled at one range were also measured.REd cell lead levels were elevated at the end of season (mean 2.64 mumol/L) and lower (mean 1.60 mumol/L) in the preseason samples. The average red cell lead level of the male shooters was 2.4 times normal and is comparable to the levels found in many occupationally exposed groups. Maximum air lead levels were 210 micrograms/m3, more than 2 times the Department of Labour OSH workplace exposure standard TWA of 100 micrograms/m3. Analysis of dust samples showed that dust at this range contained 24% to 36% lead.Although the mean time spent shooting was only 70 minutes per week the blood lead levels are similar to those previously reported for full time instructors at pistol ranges. This data confirms that lead exposure in recreational users of indoor small bore rifle ranges is a significant problem.

To determine the relative frequency of known causes of viral hepatitis in the Christchurch community.Serum samples were collected at a private laboratory from patients aged 15-75 years who had an elevated transaminase of at least twice normal.One hundred and thirty-three subjects entered the study of whom 32 were positive for Epstein Barr virus, three for cytomegalovirus, nine for hepatitis A virus, and eight for hepatitis B virus. Paired convalescent samples were obtained from 64 of the remaining 81 subjects (17 lost or declined) and seven of these were positive for hepatitis C. Assuming a similar percentage in the lost/declined group this corrects to nine.The relative frequency of viral agents causing hepatitis was Epstein Barr virus 52%, cytomegalovirus 5%, hepatitis A virus 15%, hepatitis B virus 13% and hepatitis C virus 15%. Hepatitis C virus is a common cause of viral hepatitis in the Christchurch community.

to assess trends in industrial lead exposure and the monitoring programmes in the South Island of New Zealand.during the period 1 January 1988 to 31 December 1989, industrial lead exposure was analysed in 1425 workers in at risk occupations and the efficiency of retesting programmes was determined.forty-four percent of these workers had red cell lead levels above 1.9 mumol/L, the top of the reference range for an unexposed population, and 71 individuals had levels exceeding the recommended action limits (males greater than 5.0 mumol/L, and females greater than 3.8 mumol/L). Although most occupational groups showed a small decline in mean red cell lead levels, the pattern of exposure was similar to previous reports. On average, only 43% of exposed workers were retested within the recommended period and 32% of these workers were not retested within 2 years of having a raised blood lead level.retesting was inefficient but was most reliable when industrial health nurses were employed for monitoring. Not all lead poisoning comes from the traditional lead based industries and significant decreases were found in workers whose primary exposure is to lead from petrol.

New Zealanders, because of a soil deficiency, have a low intake of selenium. To determine the impact of this on the infant population in Christchurch.we have measured red cell and plasma selenium and the selenoenzyme, glutathione peroxidase, in 70 infants less than 12 months old and related these to age and diet.the infant population as a whole had mean plasma levels of selenium and glutathione peroxidase of 33 micrograms/L and 97 U/L compared with adult values of 74 micrograms/L and 150 U/L. Infant red cell levels of 0.30 mu g selenium and 9.0 U glutathione peroxidase per g haemoglobin were similar to those in adults. The selenium status of most breast fed infants after birth remained similar to that of cord blood. Mean plasma selenium and glutathione peroxidase levels in formula fed infants were about half those of breast fed infants, and their red cell selenium was also significantly lower. These did not increase until solids were introduced into the diet. The status of the infants reflected their diet, with the concentration of selenium in formulae being 3.9-5.2 micrograms/mL compared with a mean of 13.4 micrograms/mL in breast milk.since infants in more replete selenium areas show a gradual rise in blood selenium parameters after birth, this study suggests that formula fed and some breast fed infants in Christchurch receive an inadequate selenium intake. Consideration should be given to supplementing infant formulae and perhaps also the diet of pregnant and/or breast feeding mothers.

Twenty-five patients with a renal transplant for 15 months to 19.4 years, hyperlipidaemia and stable graft function underwent three months of dietary management. Plasma lipid and apolipoprotein concentrations and lipoprotein electrophoresis were measured after a 12 hour fast at enrollment and after three months of diet. The aims of diet were to reduce energy intake in the overweight, restrict fat to 25-30% of total intake, reduce saturated fat content to less than 10% of total energy and cholesterol to less than 300 mg/d. After three months of diet there was a significant fall in mean cholesterol/HDL cholesterol risk ratio and a rise in mean HDL cholesterol concentration. Six patients reverted to a normal lipoprotein electrophoretic pattern with a significant reduction in mean total cholesterol, LDL cholesterol, cholesterol/HDL cholesterol ratio, apoprotein B and apoB/apo A-1 ratio. Most of the other patients who made dietary modifications showed some improvement in their lipid parameters. Dietary modification should be the initial approach to the management of posttransplant hyperlipidaemia.

A method for the direct direction of the delta F508 mutation in the cystic fibrosis gene has been developed and applied to the analysis of over 280 individuals including 104 individuals with cystic fibrosis. This technique allows the rapid analysis of DNA from whole blood, Guthrie card blood spots, and the antenatal diagnosis of cystic fibrosis from chorionic villus biopsy samples. Based on these analyses, the delta F508 mutation is found in 77.88% of cystic fibrosis chromosomes in New Zealand cystic fibrosis patients. Thus this test can be used to establish a direct DNA diagnosis in over 60% of cystic fibrosis patients. Approximately a further 30% are heterozygous for this mutation.

The performance of fructosamine assays in 35 laboratories was assessed over a six month period in 1987. While agreement between laboratories was poor in the range expected in diabetic patients, most laboratories were internally consistent. The interlaboratory differences are largely attributed to the calibration methods used for this test. Fructosamine results from any one laboratory must not be interpreted by comparison with data from other laboratories or the literature. Other common biochemical tests were found to suffer from similar problems, but to a less serious extent.

We report two patients with multiple sclerosis which illustrate problems in the interpretation of the cerebrospinal fluid (CSF) protein studies used to confirm diagnosis. In one case a polyclonal increase in IgG synthesis, secondary to an aseptic meningitis, masked oligoclonal banding, which was confirmed on subsequent examination. In the second case, despite a normal quantitative intrathecal IgG synthesis rate, oligoclonal banding in the CSF confirmed abnormal intrathecal synthesis of IgG. These cases show the value of combining a quantitative index of intrathecal IgG synthesis with examination for oligoclonal banding and illustrate their interpretation.

Two patients with marked elevation of plasma and very low density lipoprotein (VLDL) lipids were investigated to establish the molecular basis of their hyperlipidaemia. In one the demonstration of the apolipoprotein E 2/2 phenotype substantiated the diagnosis of type III hyperlipidaemia. In the other the E4/3 phenotype excluded this diagnosis. In both cases oligonucleotide probing of amplified DNA and isoelectric focusing (IEF) of apo VLDL identified the correct apolipoprotein E phenotype as defined by peptide mapping and IEF of purified apolipoprotein E after modification with iodoacetic acid. Probing of amplified DNA clearly distinguishes the three common variants of apolipoprotein E (E2, E3, E4) and facilitates the diagnosis of type III hyperlipidaemia.