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Aims: House dust mite allergen (Der p 1) levels are high in New Zealand and bedding Der p 1 levels have been shown to be associated with the clinical severity of asthma. The aim of this study was to measure Der p 1 levels in synthetic and feather duvets and other individual bedding items, and to examine factors affecting these levels., Methods: Reservoir dust samples were collected and analysed for Der p 1 content by ELISA from 65 duvets, 81 pillows, and 65 mattresses of 34 children and 31 adults in 34 households., Results: Der p 1 geometric mean levels (95% confidence interval) were: 13.4 microg/g (9.5-18.9) in pillows; 29.4 microg/g (19.8-43.5) in duvets; and 53.8 microg/g (39.4-73.4) in mattresses. Synthetic pillows and duvets yielded significantly more Der p 1 than feather pillows and duvets (about 7-fold and 15-fold respectively). The presence of under-bedding resulted in significantly higher pillow and duvet Der p 1 levels. Mattresses >10 years old had significantly higher Der p 1 levels., Conclusions: Synthetic pillows and duvets contain higher levels of Der p 1 than feather pillows and duvets. Advise for house dust mite sensitized individuals to use synthetic bedding does not prevent house dust mite allergen exposure.

Aims: To compare heart failure outcomes for Mäori and non-Mäori New Zealanders., Methods: Restrospective analysis of New Zealand mortality (1988-97) and hospital admissions (1989-98) due to heart failure for Mäori and non-Mäori, aged 45 years and over., Results: Mortality from heart failure was more than 8.8 times higher among Mäori males aged 45-64 years than non-Mäori (95% confidence interval 7.6 to 10.1), and 3.5 (3.1 to 4.1) times higher among Mäori aged 65 years and over. Mortality ratios for females were similar. Hospital admissions with a primary diagnosis of heart failure averaged eight times higher among Mäori males aged 45-64 and nine times higher among Mäori females compared to non-Mäori. Mäori males and females aged 65 years and over had three and four times the non-Mäori rate of admission., Conclusions: Disparities between Mäori and non-Mäori in outcomes for heart failure are high in New Zealand. Effective, evidence-based interventions have not yet impacted on populations most 'at risk'.

Aim: Earlier predictions of the incidence of hip fractures in the older adult population suggested that by 2011 the rate would rise to epidemic proportions. The purpose of this study was to compare the number hip fractures occuring in New Zealand from 1988 to 1999 with the hip fracture rate predicted in 1990 by Rockwood, Horne and Cryer., Methods: Data on the number of patients admitted to New Zealand hospitals with a diagnosis of fractured neck of femur were obtained, and compared with weighted regression and baseline predictions of Rockwood et al., Results: The numbers of hip fractures for females, from 1988 to 1993, were similar to the number predicted, yet have been significantly lower than stated predictions since 1995. For males, hip fracture numbers since 1995 were less than the weighted regressions predicted (NS)., Conclusions: Numbers of hip fractures since 1995 have been fewer than predicted. Possible reasons for maintaining the rates of hospitalisation due to fractured neck of femur at pre-1995 levels, are discussed.

Aims: To describe the self reported patterns of sexual behaviour of 4th form High School Students from the Hawkes Bay region of New Zealand, in 1998., Methods: Subjects completed a self administered written anonymous questionnaire in a supervised classroom situation., Results: 654 4th form students, median age fourteen years, completed the questionnaire--45% male, 54% female. 39.4% of the sample reported having had sex/intercourse. Maori students were nearly three times (74.9%) as likely as European students (26.7%) to be sexually active (p < 0.0001). 20.1% of these sexually active 4th formers report more than five partners. 11.9% of the total group and 30.2% of those who are sexually active, reported having first sex at age 12 or younger., Conclusions: The sexual activity of this sample of 4th form students is higher than reported previously in New Zealand, particularly so for Maori. Further research is needed to examine sexual behaviours and attitudes of young New Zealanders in the different communities to enhance the development and provision of geographically and culturally appropriate early sexuality education programmes and services. These should be designed to have particular relevance to the needs of young Maori.

Objective/hypothesis: To evaluate the use of cryoanalgesia in reducing post-tonsillectomy pain., Study Design: A prospective, randomized double-blind study of 59 consecutive patients (age range, 8-40 y) undergoing tonsillectomy for recurrent tonsillitis., Methods: All patients underwent bipolar tonsillectomy. At the completion of the tonsillectomy patients were randomly assigned to a control or a cryotherapy group. The cryotherapy patients had both their tonsillar fossa "supercooled" to between -20 degrees C and -32 degrees C for 1 minute. Patients recorded their pain using a visual analogue scale over the next 10 days. Patients were also monitored for postoperative complications, time until resumption of a normal diet, time back to work or school, and analgesic consumption., Results: The two groups were similar for age and sex. There was a 28.3% reduction in mean pain scores over the 10 days in the cryotherapy compared to the control group. This difference did not significantly depend on the day after operation or time of the day. Cryotherapy patients also returned to work or school, on average, 4 days earlier than controls. There was no significant difference in postoperative complications between the two groups., Conclusion: Cryotherapy is a new technique that significantly reduces post-tonsillectomy pain without evidence of causing additional complications.

Aim: To estimate the incidence of toxoplasmosis in pregnancy in New Zealand and consider whether there is a case for screening women in pregnancy., Methods: The risk of maternal and fetal infection with toxoplasmosis was derived by first determining the rate of maternal seroconversion based on seroprevalence studies. The age-specific number of seroconversions in pregnancy was then estimated from the birth rate. Using reported fetal infection rates after primary maternal infection, the expected number of congenitally infected infants in one year was estimated. These incidences were compared with the number of recognised cases of toxoplasmosis infection in pregnancy and the actual number of positive IgM results at the Wellington Hospital laboratory. Using national births data, this incidence was extrapolated to estimate the number of expected cases in New Zealand., Results: The annual seroconversion rate was 0.62% (95% confidence interval 0.39-0.86). On this basis, 164 primary maternal infections are expected annually with 66 fetuses being infected. Ten patients tested positive for IgM in Wellington, which averaged only one case per year being identified over the time examined in this study., Conclusions: Very few of the expected cases in pregnancy are diagnosed. Reporting rates were low when toxoplasmosis was a notifiable disease. Other means of improving detection, reporting and the avoidance of infection are discussed. More information is required before screening can be recommended in New Zealand.

This case illustrates the need to recognize a high cervical cord injury as a cause for bi-brachial weakness with intact bi-crural power, a pattern termed aptly by Sage as 'man in the barrel' syndrome. The patient who had an undiagnosed Klippel-Feil deformity had incurred his cervical injury after a collapse.

We compared daily T4 therapy with 7 times the normal daily dose administered once weekly in 12 hypothyroid subjects in a randomized cross-over trial. At the end of each treatment we measured serum free T4 (FT4), free T3 (FT3), rT3, and TSH levels and multiple markers of thyroid hormone effects at the tissue level repeatedly for 24 h. Compared with daily administration, the mean serum TSH before the administration of weekly T4 was higher (weekly, 6.61; daily, 3.92 microIU/mL; P < 0.0001), and the mean FT4 (weekly, 0.98; daily, 1.35 ng/dL; P < 0.01) and FT3 (weekly, 208, daily, 242 pg/dL; P < 0.01) were lower. A minimally elevated serum total cholesterol during weekly administration (weekly, 246.8; daily, 232.6 mg/dL; P < 0.03) was the only evidence of hypothyroidism at the tissue level. Compared with daily administration, the mean peak FT4 following weekly administration of T4 was significantly higher (weekly, 2.71; daily, 1.59 ng/dL; P < 0.0001), as was the mean peak FT3 level (weekly, 285; daily, 246 pg/dL; P < 0.01). None of the tissue markers of thyroid hormone effect changed compared to daily T4, and there was no evidence of treatment toxicity, including cardiac toxicity. During weekly T4 administration, autoregulatory mechanisms maintain near-euthyroidism. For complete biochemical euthyroidism a slightly larger dose than 7 times the normal daily dose may be required.

Aim: The aim of the study was to examine the serum albumin levels of patients admitted with hip fractures to see whether there was any relationship between serum albumin and subsequent mortality., Methods: A group of 39 consecutive patients with hip fractures was followed for a period of 12 months. The serum albumin was determined preoperatively. No patient was lost to follow up., Results: Ten patients died at 12 months. Those who died had a significantly lower serum albumin level than those alive at the end of the follow up period., Conclusions: The results of this study show that preoperative serum albumin determination in patients with hip fractures is a useful guide to postfracture mortality.

Aims: To investigate the incidence of hip fractures in Maori and nonMaori in New Zealand., Methods: The number of femoral neck fractures in patients over 60 in New Zealand for the years 1989-91 were obtained. The population data for 1991 was obtained from the 1990 census. The number of fractures was standardised for age, and the rate of fractures per 100,000 of population calculated., Results: The age standardised rates of hip fracture per 100,000 of population 1989-91 for Maori males was 197, Maori females 516, nonMaori males 288 and nonMaori females 827. These rates were higher than the rates recorded between 1973 and 1975., Conclusions: The age-specific hip fracture rate is rising in New Zealand. However in Maori males the rate is not rising.

We investigated the pituitary thyrotrophin (TSH) response to repeated oral (non-pulsatile) thyrotrophin-releasing hormone (TRH) administration and potential modifying effects of dopamine antagonist treatment under conditions of constant peripheral thyroid hormone levels. In a randomized double-blind crossover trial, seven hypothyroid subjects, euthyroid on L-thyroxine, received 1 week each of oral TRH (40 mg, 12 hourly) plus metoclopramide (10 mg, 8 hourly) and TRH (40 mg, 12 hourly) plus placebo (one capsule, 8 hourly). At the beginning and end of each treatment period five samples of blood for estimation of serum TSH were taken over 1 h before ("baseline") and seven samples over 2 h after the treatment combination was given ("stimulated"). Serum free thyroxine, free triiodothyronine and prolactin levels also were measured. Mean log10 +/- SEM (log10 mIU/l) "baseline" serum levels TSH were -0.177 +/- 0.183 (median 0.345 mIU/l (untransformed); range (r) 0.03-10.11 mIU/l; first quartile (1q) 0.22 mIU/l; third quartile (3q) 2.48 mIU/l) before and 0.182 +/- 0.107 (median 1.385 mIU/l; r = 0.45-19.8 mIU/l; 1q = 0.9 mIU/l; 3q = 1.78 mIU/l) after 1 week of treatment (p < 0.02). There were no significant differences between oral TRH plus metoclopramide and oral TRH plus placebo. Peripheral thyroid hormone levels and the "stimulated" TSH response (expressed as area under curve after TRH and metoclopramide or placebo; min.log10 mIU/l) remained unchanged after 1 week. In the absence of changes in peripheral thyroid hormone levels, oral TRH over 1 week may not result in down-regulation of anterior pituitary thyrotrophs.2+ f2p4

This is the first report of the largest study of blood pressure measurement in pregnancy in a New Zealand population using standardized definitions and methodology. Over 3,800 women who delivered in an 8-month period in the Wellington region were included in the study. Blood pressure measurement and the presence of oedema and proteinuria were recorded from booking until delivery and in the puerperium. Only 2.7% of women were unable to be contacted after delivery for details on outcomes. The results established normal ranges for blood pressure throughout pregnancy. The data show that blood pressure greater than 140/90 until 35 weeks' gestation is outside 2 standard deviations at all gestations and justifies using these measurements as the definition of hypertension in pregnancy. The fall in blood pressure in the 2nd trimester was less than 1 mm Hg per week in both the systolic and diastolic pressures. This fall was smaller than previously recorded in other studies. Gestational hypertension was the commonest blood pressure abnormality occurring in 15.2% of the population. This represented 69% of the pregnant women with a hypertensive disorder. The overall incidence of both gestational hypertension and preeclampsia was 18.5% which is higher than reported in other parts of the world. In this study obesity was significantly associated with hypertensive disorders in pregnancy. An arm circumference of > 33 cm, one of the measurements of obesity, was found in 6.8% of the study population. Even after the effect of arm circumference was taken into account, hypertensive disorders were also more common in Pacific Island women.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: The reason for the increased risk of death with fenoterol and isoproterenol in asthma is unknown but may relate to their cardiovascular effects. Deaths from asthma usually occur outside hospital where hypoxemia, with or without hypercapnia, may exist. Both of these states can influence the cardiovascular system. We investigated whether different gas mixtures modified the cardiovascular effects of isoproterenol., Method: Nine healthy men were randomly assigned to receive each of three gas mixtures to achieve (1) normoxia-normocapnia, (2) hypercapnia (end-tidal PaCO2, 50 mm Hg), (3) hypoxemia-hypercapnia (arterial oxygen saturation, 90%; PaCO2, 50 mm Hg). Isoproterenol was administered with each of the gas mixtures. Cardiovascular measurements of heart rate, blood pressure, cardiac index, ejection fraction, fractional shortening, electromechanical systole, and the QTc interval were made before administration of the gases, as well as before and 5 minutes after isoproterenol administration., Results: The changes after hypercapnia were not significantly different from those after normoxia-normocapnia. Hypoxemia-hypercapnia increased heart rate, systolic and diastolic blood pressure, QTc interval, cardiac index, ejection fraction, and fractional shortening. Isoproterenol increased heart rate, systolic blood pressure, QTc interval, cardiac index, ejection fraction, and fractional shortening while the subjects breathed the normoxia-normocapnia gas mixture. It caused similar changes with the other gas mixtures. The changes were additive., Conclusion: Isoproterenol and hypoxemia-hypercapnia will increase myocardial oxygen demand and could prove to be detrimental in severe asthma.

Objective: The study aimed to examine the impact of user charges on the dispensing of prescription medicines. The effect of social class, customer type and number of items on the incidence of payment problems was examined., Method: The study employed a two week survey of 26 pharmacies randomly selected from Wellington Pharmacy Guild. Pharmacists completed a questionnaire on each occasion user charges led to a problem dispensing a prescribed medicine. Data collected included: type of problem encountered and its outcome, customer information (including the customer's pharmaceutical benefit category), and prescription information (including the number of items prescribed)., Results: The overall incidence of payment problems was 1.5% or 1 in every 66 prescription forms processed by the pharmacists. User charges resulted in medicine dispensing failure on 56% of the problem occasions. Customers incurred debt or were funded by a social agency on the remaining 44% of problem occasions. Fifty-three percent of dispensing failures resulted in non-collection of items at the end of the survey period. Thirty-four percent of debts were outstanding at the end of the survey. The incidence of all payment problems correlated with the social "need" score of the pharmacy area and was significantly higher for children's and student's prescriptions., Conclusion: User charges may provide a greater barrier to children, students and people living in areas of high social need. Ongoing evaluation of the impact of user charges is required to ensure improved prescribing is achieved equitably [corrected].

Proximal femoral anatomy in the anteroposterior plane was assessed by analysis of roentgenograms and the relationship between the anatomy and the pattern of osteoarthrosis of the hip was explored. The neck-shaft angle, the height of the femoral head, and the offset of the femoral head were analyzed and the type of osteoarthrosis classified according to Cameron and McNab. There was a significantly greater neck-shaft angle and a greater head height in the upward and outward migratory group. Patients being treated with total hip arthroplasty who exhibit certain types of proximal femoral anatomy might be expected to have increased acetabular loading and thus greater acetabular and femoral head wear. These data may have significance in the design of femoral components and the choice of implants in patients being treated with hip arthroplasty.

Steroids induce resistance to neuromuscular blocking drugs. Betamethasone-induced resistance to vecuronium has been demonstrated in vitro, and a presynaptic site of interaction has been suggested. This study investigated whether atracurium is similarly affected. Rat phrenic nerve-hemidiaphragm preparations were bathed in a physiologic solution, and one-half were exposed to betamethasone (1 mumol/L). Dose responses were recorded for atracurium (8-13 mumol/L) and vecuronium (2-12 mumol/L) for control and betamethasone-treated preparations. In comparison to control, the betamethasone groups had significantly less depression of muscle contraction force at all concentrations of atracurium (P = 0.0004) and vecuronium (P = 0.002). The calculated ED50 (50% depression of muscle contraction force, expressed as mean +/- SEM) for atracurium was 8.83 +/- 0.62 mumol/L for controls and 11.19 +/- 0.54 mumol/L for betamethasone-treated preparations. The calculated ED50 for vecuronium was 4.72 +/- 0.41 mumol/L for controls and 6.84 +/- 0.66 mumol/L for betamethasone-treated preparations. Betamethasone therefore increased the ED50 for atracurium by 27% and vecuronium by 45%; however, the magnitudes of these differences were not significant (P = 0.74) between the neuromuscular blocking agents. These results indicate that betamethasone-induced resistance to nondepolarizing neuromuscular blockade affects both atracurium and vecuronium to similar degrees in vitro.

Objects: to investigate whether social class differences in access to cardiac surgical interventions (angioplasties and coronary artery bypass grafting) could explain social class inequalities in mortality from coronary heart disease., Methods: rates of therapeutic interventions to treat coronary heart disease were calculated for male patients aged less than 65 years admitted for the first time to Dunedin Hospital with a principal diagnosis of ischaemic heart disease (ICD codes 410-414) during the three year period from 1 January 1987 to 31 December 1989. Patients were categorised into different socioeconomic groups using the Elley-Irving social class scale., Results: no statistically significant trend across social class was observed in the cumulative incidence of cardiac surgical interventions (angioplasties, coronary artery bypass grafts). Similarly there was no statistically significant trend across social class in the incidence rates of cardiac surgical interventions, even after adjustment for age., Conclusions: social class inequalities in access to cardiac surgical intervention do not appear to explain the observed inequalities in mortality from coronary heart disease.

Effects of a regimen of regular high dose beta agonist aerosol as sole therapy (fenoterol 400 micrograms qid) on FEV1 and bronchial responsiveness to methacholine provocation were examined monthly in 16 atopic moderately severe asthmatic subjects in an open uncontrolled four months study. Eleven completed the trial, four dropped out on account of severe acute asthma and one with muscle tremor. Overall there was a small significant drop of mean prebronchodilator FEV1 after one month of 0.27 L (95% confidence interval 0.12, 0.42) but not significant thereafter. The increase of bronchial responsiveness (mean decrease of PD20 of 0.50 doubling doses of methacholine) by the end of month four did not reach statistical significance. Our study which explored potentially adverse effects of this beta agonist regimen showed only small changes of doubtful clinical significance. Drop outs due to acute asthma complicate studies such as this and make conclusions difficult.

The purpose of the study was to determine whether quantitative or discriminant analysis of the electroencephalograph (EEG) would vary significantly when the same EEG was analysed by 3 different operators. EEGs on 10 healthy volunteers were recorded on the Cadwell Spectrum AT 386, using the Electrocap (10-20 system). The EEGs were analysed independently, with each operator selecting the first 48 artifact-free epochs. The results were analysed using the non-parametric Friedman two-way analysis of variance (ANOVA) for the discrimination analysis and a one-way ANOVA for the monopolar and bipolar Absolute Power raw measures. Statistical analysis of the discriminant data showed no significant differences between operators, with 7 of 10 studies yielding the same results. The remaining 3 studies were classified either as borderline or normal when analysed by different operators. Although a series of "t" tests comparing 2 operators showed most variability occurring in Absolute Power as compared with Relative Power, Power Asymmetry and Coherence, ANOVA of the raw mono- and bipolar Absolute Power measures showed no significant differences between the operators at the P = 0.05 level. Thus the differences between the operators were non-significant when comparing quantitative EEG analyses with respect to both the raw measures and the discriminant analyses.

An electrophysiological assessment has been performed studying somatosensory, visual and auditory pathways in clinically affected and unaffected members from 4 pedigrees with the autosomal form of 'pure' familial spastic paraplegia (n = 32). In some members from 2 families, testing of all 3 sensory pathways showed abnormal results, even in those clinically unaffected. In another family, some had abnormal somatosensory and visual pathways, with no involvement of the auditory pathway. In a further family, the somatosensory and brainstem auditory pathways were abnormal, with sparing of the visual pathway. These findings indicate that the neuronal degeneration in familial spastic paraplegia extends beyond the spinal cord and involves the visual and auditory pathways. The differences between families, and the asymptomatic abnormalities in clinically unaffected members, suggest diversity in the expression of the genetic defect.

A series of guidelines for the treatment of mild to moderate hypertension have recommended that individuals with multiple cardiovascular risk factors should start treatment sooner, or at a lower level of diastolic pressure, compared with patients with an isolated elevation of blood pressure. A Markov cohort model was constructed to examine this claim. The cohorts consisted of mild to moderately hypertensive men with added cardiovascular risk factors: smoking, raised serum cholesterol, and presence of left ventricular hypertrophy on electrocardiogram. The results of the model confirm that the prognosis of hypertension is highly dependent on the presence of other risk factors. The average remaining life expectancy of two patients of identical age and level of diastolic pressure varied by as much as 10 to 24 years, depending on the presence of other risk factors. Depending on the patient, the gain in life expectancy due to treatment of hypertension ranged from 0.11 years to 1.03 years. However, the results also indicated that the additional benefit as a result of 'targeting' in people with multiple risk factors did not exceed 0.47 years for any of the patient categories analysed. The nature of these conclusions remained unaltered despite the use of quality-adjusted life years (QALYs), and varying assumptions about the benefit of treatment. In comparison the model indicated that the benefits of smoking cessation among hypertensive men were three to eight times greater than the expected benefits from antihypertensive therapy.

The cardiovascular, respiratory, and hypokalemic effects of repeated inhalation of fenoterol, albuterol, and isoproterenol were compared in 12 subjects with stable asthma according to a double-blind, crossover design. Ipratropium bromide served as a control providing bronchodilatation without extrapulmonary effects. Subjects inhaled the beta-agonists on an equal-weight basis (400 micrograms) at 0, 30, 40, and 45 minutes. Measurements of heart rate, blood pressure, total electromechanical systole (measure of inotropic activity), preejection period, QTc interval, plasma potassium levels, and forced expiratory volume in 1 second were made 5 minutes after each dose and again at 60 and 75 minutes. There were no differences in the bronchodilating effect between the beta-agonists. However, both fenoterol and isoproterenol resulted in greater positive inotropic stimulation than did albuterol, and fenoterol caused a greater fall in plasma potassium levels than did the other beta-agonists.

Field trials of the "Mental and Behavioural Disorders" section of the 1987 draft of the ICD-10 have been co-ordinated for the World Health Organisation by a number of regional centres. The design of the field trials and the major features of ICD-10 are briefly discussed. The results of the field trial in the Western Pacific region are described, and compared with the results of the original DSM-III field trials. ICD-10 appears to be an acceptably reliable diagnostic system, and the ratings of its feasibility and utility by participating clinicians suggest that it will be seen as a distinct advance over ICD-9.

Fine-catheter aspiration cytology of the peritoneal cavity was successfully undertaken in 25 of 27 hospital inpatients with acute abdominal pain because it was not clear whether they required urgent laparotomy. Cytological specimens were prepared by the cyto-sieve technique. The main test criterion was the percentage of neutrophils in the peritoneal cell sample. The decision before the test about urgent laparotomy was correct in 14 of the 27 patients, whereas the decision after the test was correct in 26 of the 27 patients (p = 0.001). 4 patients were saved unnecessary laparotomy and 8 further delay in laparotomy.

2 cases of posterior fossa arachnoid cyst are discussed. In the first, it is likely that perinatal factors were responsible for the temporal lobe pathology and the formation of the cyst. Progressive dilatation of the temporal horn may have then been caused by obstruction from the cyst. In the second case, minor head trauma was a possible mechanism for the cyst production, although it seemed irrelevant to the mode of clinical presentation.

The complexity of amiodarone disposition in blood and tissues gives rise to difficulty in determination of optimal therapeutic monitoring strategies. We have defined the within-patient variability of plasma and erythrocyte amiodarone and desethylamiodarone concentrations and electrocardiogram intervals [PR and corrected QT (QTc)] in 27 patients each sampled on three to four occasions during long-term stable amiodarone therapy. All individual repeated measurements were included in the concentration-effect analysis. The mean within-patient coefficients of variation for amiodarone and desethylamiodarone were significantly greater in erythrocytes, 46.0 and 24.5%, respectively, compared with plasma, 12.7 and 12.3%. Amiodarone and desethylamiodarone were significantly greater in erythrocytes, 46.0 and 24.5%, respectively, compared with plasma, 12.7 and 12.3%. Amiodarone and desethylamiodarone were strongly correlated (r = 0.29 p less than 0.004). There was a 10-fold variability in erythrocyte amiodarone for a given plasma level. These data emphasize the highly variable cellular distribution of amiodarone and desethylamiodarone in the same patient on stable dosage over time. Plasma amiodarone was significantly correlated with dosage (r = 0.98), and percent change in QTc, (r = 0.56, p less than 0.0001), but there was a fourfold variation in plasma amiodarone for a given QTc. Side-effect frequency was not related to plasma or erythrocyte amiodarone or desethylamiodarone concentrations. A clinically useful relationship between plasma concentration and effect could not be consistently demonstrated for amiodarone in the same individual during stable dosage.

A random national survey of 50 general practitioners was undertaken to ascertain current trends in the pharmacological management of hypertension. Forty general practitioners entered the study, and scripts written by them over a two month period in 1988 were collected and recorded by the pharmaceutical pricing offices of the health department. The general practitioners provided details on whether the script had been written for hypertension, as well as the age and sex of the patients. Information from 37 general practitioners was available for study, involving 2675 scripts written for hypertension for 1858 patients. Sixty point two percent of the treated hypertensives were female, and 58.9% were aged over 60 years. The most commonly prescribed antihypertensives were the diuretics (47.1% of patients) and beta blockers (47.9%). They were followed by angiotensin converting enzyme inhibitors (18.2%) and calcium antagonists (9.7%). There was substantial variability in the prescription of antihypertensives with respect to the age and sex of the patients treated; the mean costs and duration of supply of different generic drug types; and the prescribing habits of general practitioners. By generic type, the mean monthly costs of therapy ranged from $3.77 (diuretics) to $48.19 (calcium antagonists). The age and sex adjusted geometric mean script costs ranged from $17.78 to $49.11 per month (median: $29.30). It seems unlikely that the observed degree of variability is explained by differences in the severity of hypertension between general practice populations.

The hypereosinophilic syndrome groups together patients with idiopathic eosinophilia and diffuse organ infiltration with eosinophils. It appears to be a continuum of disease from the asymptomatic patient with skin and heart disease at one end to eosinophilic leukaemia at the other. A case is described of a young woman who presented with asthma, mononeuropathy multiplex and eosinophilia and subsequently developed eosinophilic gastroenteritis, vasculitis and probable myocarditis. The response to prednisolone has been pleasing.

The risks and benefits of treating mild to moderate hypertension (defined as a diastolic blood pressure level between 90-114 mm Hg) were quantified in order to assist clinical decision making. Presenting such information ought to be an essential part of the process of obtaining the patient's consent for treatment. Using estimates from clinical trials that antihypertensive drug therapy reduces all-cause mortality by 11% and stroke incidence by 39%, the benefits of treatment--expressed as the average number of people needing to be treated annually in order to prevent one death--ranges from 333 to 3393 in men, and from 508 to 5094 in women. The average number of people needing to be treated annually to prevent one stroke ranges from 281 to 4292 in men, and from 253 to 13,477 in women. The benefits of treatment are greatest in men, in the older age groups, and at higher diastolic blood pressure levels. Compared to the benefits, the annual risk of developing a side effect of the medication is much higher.

The hypokalaemic effects of equal doses (5 mg) of fenoterol, salbutamol, terbutaline and an equal volume of saline administered by nebulization were compared in eight healthy subjects. Plasma potassium was measured at 15-min intervals for 60 min and at 90 min, 2, 4 and 6 h following administration. Fenoterol, salbutamol and terbutaline all significantly decreased plasma potassium when compared to saline; however, the magnitude and duration of this effect differed between the active agents. Both fenoterol and terbutaline significantly reduced plasma potassium for 4 h whereas salbutamol was only different from 30 to 120 min. The maximum decrease occurred with fenoterol (-0.78 mmol/l), followed by terbutaline (-0.70 mmol/l) and salbutamol (-0.33 mmol/l). Both terbutaline and fenoterol had a significantly greater effect compared with salbutamol. When administered by nebulization fenoterol and terbutaline are likely to have a greater hypokalaemic effect than salbutamol and this effect is likely to be more long lasting.

We have investigated whether oral theophylline potentiated the cardiovascular effects of fenoterol administered by metered-dose inhaler. Eight healthy subjects were investigated on four occasions. On successive days (1 and 2), the subjects were given doses of 400 micrograms, 600 micrograms, and 800 micrograms of fenoterol at 15-minute intervals (total dose, 1.8 mg) or matched placebo. Systolic time intervals, blood pressure, and the ECG were recorded at baseline and five minutes after each inhalation. Thereafter, the subjects were treated with slow-release theophylline for eight days. On days 9 and 10, the procedures on days 1 and 2 were repeated. The order of treatment was applied according to a crossover Latin-square design. The effects after theophylline alone were no different from placebo. Theophylline potentiated those hemodynamic effects of fenoterol due to enhanced cardiac sympathetic tone (mean +/- SE) as measured by a decrease in Q-S2I (-41.6 +/- 7.6 ms vs -27.3 +/- 5.9 ms; p = 0.0004), an increase in systolic BP (23.5 +/- 2.8 mm Hg vs 9.0 +/- 5.3 mm Hg; p = 0.00001), and an increase in heart rate (15.8 +/- 1.6 bpm vs 9.1 +/- 3.7 bpm; p = 0.0013). The responses mediated by beta 2-adrenergic receptor stimulation, namely, a decrease in PEP and diastolic BP, were not potentiated. Although fenoterol prolonged the Q-Tc interval and decreased T-wave amplitude, these effects were not potentiated by theophylline. Oral theophylline potentiates the positively inotropic and chronotropic effects of fenoterol.

A prospective study of all patients (15 years and over) admitted to acute medical beds at a medium sized general hospital was carried out. For each patient, demogaphic data, day and time of admission, consultant in charge and the main reason for admission, were recorded. The patients hospital stay was analysed to determine the extent of the bed blocking problem. Sixty-two percent of total days stay required acute medical intervention, 32% was spent receiving nursing care only, 4% paramedical activities and 3% awaiting outside medical consultations. The three major factors found to influence total days stay were age, living situation and reason for admission. Patients over 75 years, living alone or who were admitted with a cerebrovascular accident/for nursing care were identified as bed blockers. An age related geriatric service may speed up the recovery of these patients and result in a more appropriate use of hospital resources.

A randomized, controlled clinical trial, of sequential design, was undertaken to determine whether fine catheter aspiration cytology of the peritoneal cavity, using the percentage of neutrophils in the sample as the main test marker, reduces errors about urgent laparotomy in patients admitted to a surgical unit with acute abdominal pain. One hundred and forty-four patients with acute abdominal pain were studied. Of these, 26 were excluded because the test was unlikely to be useful and 20 did not consent. Conventional clinical assessment was undertaken and then the subjects were randomly allocated to have a peritoneal cytology test or not. After the test result was made available, the surgeon(s) decided whether to operate or continue conservative treatment. The correct decision was later ascertained by a blinded clinical referee. With the entry of the 98th patient the difference between the groups achieved the 5% significance level. The groups were well-matched in regard to demographic and other variables. The decision about urgent laparotomy was incorrect in only 8.2% of the test patients, compared with 28.6% of the others. It is concluded that fine catheter aspiration cytology of the peritoneal cavity is likely to reduce the numbers of unnecessary or delayed laparotomies when used in most patients admitted with acute abdominal pain.

We have compared the acute bronchodilator response following salbutamol 200 micrograms and fenoterol 200 micrograms with ipratropium 80 micrograms, from metered dose inhalers in ten subjects with severe partially reversible airflow obstruction. Treatment with the combination resulted in a similar degree of bronchodilation but with a significantly longer duration of action.

We have studied 27 patients on long-term treatment (6-60 months) with amiodarone (dose range 350 mg per week to 2800 mg per week) to ascertain whether the corrected QT interval could predict plasma amiodarone or plasma desethylamiodarone concentration. The patients were assessed on three or four occasions one month apart. There were positive correlations for delta % QTc and plasma amiodarone and delta % QTc and plasma desethylamiodarone. There was approximately a four-fold variation for delta % QTc and plasma amiodarone. This variation was not accounted for by between-occasion variation in the QTc interval, as the coefficient of variation was 2.1%. In six of the patients delta % QTc either decreased or did not change. delta % QTc is not a reliable predictor of plasma amiodarone concentration in the individual patient over time.

Erythrocyte (ENH3) and plasma (PNH3) ammonia levels, liver function tests and plasma valproate concentration were measured in 81 epileptic patients, comprising three therapeutic groups: Group 1 (23 patients) received sodium valproate (VPA) monotherapy, group 2 (33 patients) received sodium valproate combined with phenytoin, carbamazepine, phenobarbitone and/or primidone and group 3 (25 patients) received one or more of these anti-epileptic drugs without sodium valproate. The mean ENH3 and PNH3 of patients in group 1 (41.1 +/- 30.7 mumol l-1 and 37.1 +/- 31.8 mumol l-1, respectively) and group 2 (44.5 +/- 21.3 and 37.6 +/- 21.4 mumol l-1, respectively) were significantly (P less than 0.01) higher than those in group 3 (28.7 +/- 10.6 and 21.5 +/- 7.8 mumol l-1, respectively) and the reference range (30.1 +/- 7.9 and 20.8 +/- 5.7 mumol l-1, respectively). Hyperammonaemia was more prevalent amongst patients in group 2, for both ENH3 (45.5%) and PNH3 (54.6%), than amongst patients in group 1 (30.4% and 52.2%, respectively) and group 3 (8% and 8%, respectively). There was a significant (P less than 0.05) positive correlation between plasma VPA and total bilirubin concentrations. Chronic VPA therapy was also associated with an increase in bilirubin concentrations measured on average four months apart.

Two instances of acute encephalopathy following petrol sniffing in Australian Aboriginals are reported. In one case recovery was incomplete 6 weeks after cessation of exposure to the toxin.