Biomedical subjects
Publications and source records attributed to E Byrne.
We report the case of a patient with extensive extracranial arteritis in whom intermittent claudication of the tongue was followed by incipient gangrene and in whom response to steroid and anticoagulant therapy was rapid. The importance of recognizing this unusual presentation of temporal arteritis and instituting therapy early is emphasized.
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While a prisoner-of-war in Malaya from 1942-1945, a 29-year-old man developed a painful sensorimotor neuropathy, bilateral central scotomata and sensorineural deafness. Examination 34 years later, after a long period of adequate nutrition, revealed considerable residual deficit. Nerve conduction studies suggested axonal degeneration with prominent collateral reinnervation. This case of Strachan's syndrome is reported to draw attention to the limited functional recovery and to focus attention on this condition at a time when famine conditions are rife in Southeast Asia.
Cis-platinum was used in the management of four patients with metastatic carcinoma of the adrenal cortex. In each instance, clinical and objective response was observed. This agent would appear to warrant further trial in the management of this rare tumour.
Twenty-five patients with biopsy-proven giant cell arteritis (GCA) were treated at the Royal Adelaide Hospital from 1973 to 1978. Three patients had a normal ESR on presentation. Four patients developed monocular blindness, one had gangrene of the tongue, and one had a brain-stem stroke. Six patients had concurrent autoimmune thyroid disease, one suffered from myasthenia gravis and one had ulcerative colitis--a significant observation in view of the suggestion that GCA has an immunological basis.
Case fatality ratios for the stroke syndrome are reported for patients admitted to two South Australian Teaching Hospitals during the period 1968--77. A fall in intrahospital acute phase stroke mortality was seen from 28.1% of stroke admissions in 1968--69 to 18.3% in 1976--77. Male stroke mortality rate fell from 28.1% to 17.0% and female mortality rate from 28.4% to 19.9% over this period. Changes in admission criteria and in duration of hospitalisation do not appear to account for this improvement in mortality figures. The age distribution of the total inpatient stroke population did not change significantly over this period. An increase in all hospital admissions of 46% over the period was paralleled in the stroke subgroup 15.5%. No improvement in therapeutic methods over the period in question appears to fully account for the improvement in mortality figures and it is inferred that these figures indicate an overall decrease in stroke severity on presentation.
A case of selective necrosis of the central grey matter of the caudal spinal cord secondary to severe prolonged hypotension is presented. The hypotension was due to localised dissection of the ascending aorta which did not interfere structurally with any of the spinal cord vasculature.
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A case is presented in which onset and cessation of retinal migraine attacks were clearly related to prescription of a contraceptive pill. Retinal migraine is briefly discussed and the importance of recognizing this rare complication of oral contraceptive use is emphasized.
A case is reported of water intoxication and cardiac conduction disturbances occurring as a late complication of carbamazepine therapy for trigeminal neuralgia. These uncommon but potentially hazardous complications of therapy are reported because of the wide use of carbamazepine as the agent of choice for trigeminal neuralgia and as an anticonvulsant.
Three cases of multiple cerebral nocardial abscess are presented. All were cured by a combination of chemotherapy and surgery, a unique experience. Early detection, appropriate chemotherapy, absence of underlying immune malfunction, and surgically remediable disease are good prognostic indices in cerebral nocardiosis. If other adverse prognostic factors are absent, however, multiple abscess formation does not preclude the possibility of cure. Accurate localisation of nocardia cerebral abscesses by computerised axial tomography is a great help in management if multiple lesions are present.
Quantitation of hepatic microsomal enzyme induction in epilepsy has a theoretical role in identifying patients at risk of metabolic bone disease, in assessing drug compliance and in predicting anticonvulsant dose/serum level relationships. The clinical usefulness of antipyrine half-life as a measure of enzyme induction in chronic epilepsy has been explored in this study. Mean antipyrine half-life in a control group (mean 10.7 hours SD 2.0) was significantly longer than in an epileptic group (mean 5.6 hours SD 2.3). Antipyrine t1/2 did not distinguish epileptics with osteomalacia from other epileptic patients and half-lives were similar in patients treated with phenytoin and a barbiturate to those in patients on phenytoin alone. No significant correlation was found between antipyrine half-life and phenytoin dose or between half-life and phenytoin level. In 5 patients with low serum levels of anticonvulsant, antipyrine kinetics suggested poor compliance in 3 and rapid hepatic phenytoin degradation in 2. This study suggests that measurement of antipyrine half-life may be useful in assessing drug compliance, but is not useful in predicting the onset of osteomalacia or dose/serum level relationships.
From 1969 to 1976 there was a significant reduction in mortality for various forms of ischaemic heart disease (IHD) in inpatients at the Royal Adelaide Hospital. The mortality rate for all forms of IHD fell from 22.9% to 8.8% in men, and from 26.7% to 14.5% in women; the rate for acute myocardial infarction fell from 28.5% to 16.1% in men, and from 38.4% to 25.1% in women; and the mortality rate for chronic IHD fell from 13.2% to 1.1% in men, and from 13.8% to 2.0% in women. A less marked decrease in mortality from acute myocardial infarction occurred in the general population. Numbers of hospital patients increased within each category of IHD. Admission of patients with less severe illness and changes in age and sex distribution may partially account for the observed reduction in hospital mortality.
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Three of five siblings developed a progressive neurological disorder during infancy or early childhood characterized by cerebellar ataxia, choreoathetosis and peripheral neuropathy. Immunological studies revealed a marked selective deficiency of serum IgE in all three affected siblings. There was evidence of chromosomal instability in the three affected siblings and in one of the parents. One of the affected siblings also developed acute lymphoblastic leukaemia. In spite of many resemblances, this syndrome differs from classical or complete ataxia telangiectasia in that oculocutaneous telangiectases were lacking, the serum IgA and alpha-fetoprotein levels in this family were normal, there was no gonadal dysgenesis, and the cytogenetic findings were atypical.
AIMS: To determine whether additional muscle fibre wasting of the ipsilateral vastus lateralis muscle occurs in the early postoperative period after total hip arthroplasty for osteoarthritis of the hip and whether there is an improvement in preoperative measures of quadriceps muscle thickness, strength, pain and function over a 5-month postoperative period. METHODS: Twelve patients had ipsilateral needle quadriceps biopsy for muscle morphology and bilateral quadriceps muscle thickness ultrasound preoperatively, 5 days and 4 weeks postoperatively and a further muscle thickness measurement at 5 months. Seven additional patients and five age-matched control subjects had bilateral quadriceps muscle ultrasound thickness preoperatively, 6 weeks and 5 months postoperatively, with assessment of quadriceps muscle dynamometry, pain scores and Timed Up and Go (TUG) test. RESULTS: Preoperatively, all 19 patients demonstrated significant atrophy of the ipsilateral compared with the contralateral quadriceps muscle (P = 1.8 x 10(-7)) on muscle ultrasound, which persisted at 5 months follow up (P = 0.009). Muscle morphology preoperatively showed type 2A and 2B muscle fibre atrophy on needle muscle biopsy, with further atrophy of all three fibre types (P = 0.029) at 5 days postoperatively associated with a fibre type shift from type 1 to 2A fibres (P = 0.0011) at 1 month. There was improvement in hip pain postoperatively and a significant improvement in the TUG test (P = 0.007). However, there was no improvement in muscle strength on dynamometry. CONCLUSIONS: There is significant ipsilateral quadriceps atrophy and weakness with 2A and 2B fibre atrophy preoperatively in patients with osteoarthritis of the hip with exacerbation and further atrophy of all three fibre types 5 days postoperatively. Postoperative follow up showed that the reduction in ipsilateral quadriceps muscle thickness persisted at 5 months despite physical rehabilitation. Patients did note significant improvement in pain postoperatively and improvement on functional assessment with the TUG test. Other therapeutic strategies may have to be developed to reverse disuse muscle atrophy.
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