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Objective: A clinical and microbiological review of cases of subdural and epidural empyema. Design, setting, patients: A 10‐year retrospective review of patients with subdural and epidural empyema in all Brisbane hospitals with neurosurgical units. 10 this period there were 14 cases. Results: The paranasal sinuses were the primary focus in 8 of the 14 cases, the middle ear in 3 and a surgical or traumatic wound in 2. One case occurred as a complication of Haemophilus influenzae meningitis. Streptococcus, particularly Streptococcus milleri, were the causative organisms in all cases of sinus origin, most of which occurred in the second decade of life. An intracranial collection was considered in the differential diagnosis within 24 hours of admission in all 3 cases of otic origin but in only 2 of the 10 sinus or post‐traumatic cases. The most common initial diagnosis was viral or partially‐treated bacterial meningitis (8 of 13 cases). The initial computed tomographic (CT) scan was not diagnostic in 3 of 11 patients. No patient Was successfully treated without surgery, and all 3 deaths in the series were associated with delayed surgery. Conclusions: Subdural and epidural empyema is an uncommon condition. The majority of the cases in this series were associated with sinusitis, and Streptococcus milleri was the commonest organism identified. The condition remains a diagnostic challenge; CT scanning cannot be relied upon although the use of intravenous contrast arid more modern scanners has improved the diagnostic yield. Surgical drainage and early aggressive antimicrobial therapy are essential to avoid significant morbidity and mortality.

Objective: To evaluate the incidence of invasive Haemophilus influenzaetype b (Hib) disease relative to rates of Hib vaccination in a well defined population. Design and subjects: Cases of invasive Hib disease were identified by active laboratory surveillance for the period 1989–1994, and retrospectively for 1985–1987. Vaccination rates were determined by telephone interview of families with children aged 0–4 years, identified in a random telephone directory sample of 4000 households. The receipt and time of vaccination were validated from general practitioner records for a 50% subsample of children. Setting: Sydney Statistical Division, with a population of 263 758 children aged 0–4 years in 1990. Results: Hib vaccination rates were relatively low before the introduction of government‐funded vaccination programs in May 1993, especially for children under 18 months for whom multiple doses are required. Rates rose from fewer than 9% (95% CI, 4%–13%) in May 1993 to 48% (CI, 40%–56%) in August 1993 for children under 18 months, and from 31% (CI, 26%–36%) to 45% (CI, 40%–51%) for children aged 19–60 months. The age‐specific incidence of Hib disease was inversely related to the vaccination rate. Forecasting of Hib disease incidence by the Box‐Jenkins method showed that from September 1993, when about a 50% vaccine uptake was achieved in the eligible age group, overall incidence was substantially lower than expected. Conclusions: These data provide good evidence that the decrease in Hib disease incidence in 1993–1994 is an effect of vaccination, and not annual or seasonal variation. The impact of Hib vaccination appears to have been greater than would be expected from protection of vaccinated children alone. Invasive Hib disease is likely soon to become a rare cause of serious childhood infection in Australia.

Objective:To assess the impact of rotavirus gastroenteritis on young children attending a paediatric hospital, their families and the health care system. Design:Cross‐sectional descriptive survey. Setting:New Children's Hospital (Royal Alexandra Hospital for Children), Sydney, New South Wales, 15 July to 4 October 1996. Participants:Children aged under three years attending the Emergency Department with acute diarrhoea as the presenting symptom. Outcome measures:Cases of rotavirus infection confirmed by enzyme‐linked immunosorbent assay by age; rotavirus serotype; gastroenteritis severity score; estimated costs to parents (lost pay or leave, travel, medication and other expenses) and to the health care system (visits to Emergency Department and other health care workers, hospital admissions). Results:280 children were recruited (73% of 384 children who met the inclusion criteria and 27% of the 1037 aged under three years with acute gastroenteritis). Rotavirus was detected in 188 of the 280 (67%); most isolates were serotype G1 (86% of the 174 serotyped). Of the 188 children with confirmed rotavirus infection 78% were aged 7‐24 months and 82% visited at least one other health care worker, usually a general practitioner. Seventy (37% of the 188) were admitted to hospital; 33 of these (47%) were aged 13‐24 months. Estimated mean total cost per episode of rotavirus gastroenteritis was $1744 for children admitted to hospital and $441 for children not admitted. The mean cost to families was $493 for children admitted to hospital and $228 for children not admitted. Conclusions:Rotavirus gastroenteritis has a significant impact on young children, their families and the health care system. Prevention of severe disease through routine infant vaccination would be potentially cost‐effective.

This article has emphasized a basic approach to coma. First, the patient must have airway, breathing, and circulation protected. If the etiology of coma is in doubt, a broad metabollic screen is necessary. Table 5 demonstrates the major differences between structural and metabolic coma. Usually, history alone is sufficient to make an accurate diagnosis. If history or neurologic examination suggests a structural cause for the coma, then a cranial CT scan is mandatory. An electroencephalogram is often helpful, particularly in metabolic coma, and at times may even show structural abnormalities not demonstrated by CT scan. Rapid assessment and treatment is critical because coma is the clinical manifestation of brain failure, and often irreversible injury will occur if treatment is slow or incorrect.

Over a 24-month period we evaluated 14 patients with neurologic disease associated with cocaine abuse. Five patients developed previously unreported complications: anterior spinal artery syndrome, lateral medullary syndrome, transient ischemic attacks in the middle cerebral artery and vertebrobasilar artery territories, and partial motor seizures. The recent availability of crack has led to a great increase in neurologic problems associated with the use of this drug.

ABSTRACT The results of 2439 blood cultures that were taken in an acute children's hospital over a two‐year period were reviewed. Three hundred and twenty‐two organisms were cultured from 310 patients. One hundred and thirty‐five (5.5%) isolates were considered to be pathogenic and 187 (7.7%) isolates were considered to be contaminants. Coagulase‐positive staphylococci and enteric Gram‐negative organisms were the isolates of which the significance was most difficult to determine. Community‐acquired bacteraemia that affected children of less than five years of age was caused by Haemophilus influenzaein 65% of cases. Staphylococcus aureuswas the major pathogen in older children. In 20% of cases, antimicrobial agents were commenced or changed after blood culture results. Delayed or inappropriate therapy was significantly more common in patients without an apparent focus of infection. The results of our study suggest that narrow spectrum antimicrobial agents can be used as appropriate empiric therapy for unlocalized infections in previously‐well children. In children of between three months and five years of age, treatment should be directed against Haem. influenzaeand Streptococcus pneumoniae,and in children of over five years of age, antistaphylococcal therapy should also be included.

AbstractStudy of profiles, perpendicular to the fold-axes, shows that the folding is disharmonic. Nearly every s?surface is one of d?collement. In some exposures the quartzites are reduplicated by superposed recumbent-folds without infolds of other material. The contacts are tectonic and not stratigraphic. Incipient boudinage is frequent, and nearly all surfaces show well-developed b?lineation.

AbstractPresent knowledge of the tectonics of the Struan area is summarized. Recumbent-folds and incipient boudinage are recorded in the Struan Flags. The different types of lineation present are described; it is pointed out that all types present are mutually parallel. Simple kinematic analysis of an exposure north-west of Dalnacardoch, demonstrates that the lineations coincide more or less closely, with the axis of rolling; they are therefore b-lineations. The need for further field-work is stressed, and the type of data required is indicated.

AbstractThe principal tectonic terms employed are defined. A specimen of sheared quartzite from Corshellach is described. Shear-planes, drag-folds, and lineation are syngenetic. Their geometric relations show that the lineation is in b. Also described is a specimen of folded marble and graphite schist from Urlarmore. Elongated bodies of graphite schist represent tectonic thickening along the antiform hinges. Their maximum dimension, which is much greater than any other, is parallel to the lineation, but they have not suffered extension in this direction. The form of folds and rotated bodies shows that the lineation is again in b. The sense of the movement was towards the south-west. It is believed that throughout mid-Strathspey and Strathavon similar lineations bear the same relations to the kinematic directions.

Reanalysis of data for individual and group learning curves of mental retardates supported the relevance of intelligence and past experience in learning.

AbstractOn Ord Ban, quartzite in superposed recumbent folds trending north?south is separated by a slide from mica-schist, granulite, and marble folded in monoclines trending east?west. The reasons for distinguishing between these two styles of folding are given, and the characters of the two styles are contrasted. A fold in quartzite and a fold in marble are described in detail, and kinematic interpretations are attempted. It is concluded that evidence of an early deformation involving mylonitization has been preserved in the quartzite, and that the latest tectonic event distinguishable was the production of the monoclines with attendant twinning of calcite and dolomite.

AbstractIt has been claimed that the hinge of one of the two major recumbent folds of the S.W. Highlands is exposed near Ben Lui. In this paper it is claimed that the form of the outcrops permits the existence of this recumbent fold only if the fold-axis plunges towards the south-west. Evidence is given that the plunge is in fact towards the west, and on this basis a profile has been constructed to illustrate the observed geometrical relationships of the rocks.

AbstractPetrofabric analyses of marble specimens from three widely separated localities in Mid-Strathspey and Strathavon are recorded. Preferred orientation of [0001] in the constituent grains of calcite conforms to a B-tectonite pattern, the symmetry axis (B) of which coincides with the baxis of the megascopic fabric (lineation and fold axis) at each locality. Development of {011?2} lamellae in calcite grains is attributed to late minor compression, the direction of which is more or less horizontal and trends between N.E.?S.W. and E.N.E.?W.S.W.

Background Pediatric fibroblastic/myofibroblastic tumors (PFMTs) can be challenging to definitively classify. Large case series or diagnostic updates have not been recently published despite identification of molecular alterations that could improve diagnostic accuracy. Our review of the literature found that over two-thirds of the more than 30 types of PFMTs harbor recurrent molecular alterations. We performed an institutional review of PFMTs to highlight limitations of a predominantly morphological classification, and evaluated the utility of a next-generation sequencing assay to aid diagnosis.Methods PFMTs identified over a period of 12 years were reviewed, categorized per the new WHO classification, and tested using the Oncomine Childhood Cancer Research Assay.Results Eighty-seven specimens from 58 patients were reviewed; 50 were chosen for molecular analysis, 16 (32%) lacking definitive classification. We identified alterations, some novel, in 33% of assayed cases. Expected alterations were identified for most known diagnoses and mutations were identified in 6 of 16 tumors (38%) that were initially unclassified.Conclusion We confirmed a significant subset of PFMTs remain difficult to classify using current criteria, and that a combined DNA/RNA assay can identify alterations in many of these cases, improving diagnostic certainty and suggesting a clinical utility for challenging cases.

Objective: To estimate morbidity due to Bordetella pertussis infection in a representative population of Australian adults. Design: Telephone survey using structured questionnaire. Participants: Adults (aged 20 years and over) notified with pertussis to a public health unit in western Sydney between 1 December 1997 and 31 May 1998. Main outcome measures: Duration of cough; time to improvement; symptoms and complications; time to diagnosis; health resource use; lost work days. Results: Of 90 eligible patients, 73 (81%) completed questionnaires. Cough lasted a median of 60 days, but persisted over 90 days in 20 people (27%). Presentation was within a median of seven days of symptom onset, but diagnosis of pertussis took a median of 21 days. Participants reported a mean of 3.7 general practitioner visits and 1.2 prescription drugs. Of those employed, 17 (35%) missed more than five work days (range, 0‐93 days). Conclusions: B. pertussisinfection in adults can result in prolonged, significant disruption to social and working life. Results suggest that, in 1998, there were more than 8000 general practitioner visits and 15 000 lost work days caused by pertussis in Australian adults. MJA 2000; 173: 74‐76

ABSTRACT A patient from Vanuatu with a mycetoma of the foot of 25 years’ duration is described. Culture of a biopsy specimen from the foot grew a fungus which was identified as Acremonium falciforme.This agent has not been described previously in association with mycetomas in the Pacific region.