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Assessment of medical fitness to drive can be a sensitive and difficult task, particularly when it involves a condition such as epilepsy, where impairment is intermittent. The patient, their doctor and the driver licensing authority (DLA) each have responsibilities, both to the patient and to the wider community of road users. DLAs in Australia have shifted most of the responsibility for determining fitness to drive to the treating doctor. This creates a conflict of interest and may lead to unsafe decisions, damage to the doctor-patient relationship, interference with medical management and legal vulnerability for the doctor. Australian neurologists have argued for a system in which the treating doctor provides objective information about the patient's condition, rather than an opinion on fitness to drive, and the DLA uses that information to determine fitness. This must be supported by an expert review process. Although drivers are legally obliged to notify the DLA when they become unfit, most people are unaware of this law. However, passing this responsibility to doctors in the form of mandatory reporting is counterproductive to road safety. Language: en

OBJECTIVES: To determine the clinical features, response to treatment and outcome of petrol sniffers presenting to Perth's teaching hospitals. DESIGN: Retrospective study of all admissions to Perth's tertiary referral hospitals that were related to petrol sniffing from 1 January 1984 to 31 December 1991. RESULTS: Twenty-five patients (22 male and 3 female) were admitted with a diagnosis of intentional petrol sniffing. Five presented with acute petrol intoxication as the result of an isolated action. The remaining 20 patients were "chronic petrol sniffers". The mean age was 17.7 years (range, 5-27 years). Twenty patients were Australian Aborigines, including 18 of 20 chronic petrol sniffers and the three females. In the chronic petrol sniffers, a high prevalence of seizures and an alarmingly high case fatality ratio (8 of 20), usually by sudden death, were found. An altered mental state was universal, manifesting as drowsiness, delirium or stupor. Generalised tonic-clonic seizures occurred in 14, three with status epilepticus. Myoclonus (9), chorea (8) and cerebellar ataxia (appendicular and truncal) (13) were common. High blood lead levels on presentation were associated with a poor prognosis (survivors v. deaths, P = 0.002). Eighteen of the 20 patients were treated with specific agents to reduce the lead load, but the results were extremely disappointing. CONCLUSION: Petrol sniffing is an important cause of sickness and death in young people from some rural Aboriginal communities. It can cause sudden death or irreversible encephalopathy. Those severely affected have a poor prognosis, despite treatment. Effective strategies for prevention are needed. Language: en

The smuggling of illicit drugs, either swallowed or inserted into the rectum or vagina, is gaining in popularity, particularly in view of the difficulty of its detection and the potentially large financial gains. Such contraband includes heroin (especially in Western Australia), cocaine, and marijuana and its derivatives. This practice is not without complications--drug intoxication, which may be fatal, and intestinal obstruction by foreign bodies have been reported. We review the cases of "body packing" reported in the literature and those detected in Western Australia over the past two years, and describe three cases of the ingestion of heroin-filled condoms, with resultant complications.

A case of cephalic tetanus that occurred in a fully immunized patient is described. An 18-year-old man presented with bilateral facial spasms, without trismus or more generalized involvement, followed by facial weakness. The difficulties in clinical diagnosis and the contribution of electrophysiological studies to the management of such patients are highlighted. The variable level of protection that is conferred by immunization is discussed.