Late-life-onset panic disorder: clinical and demographic characteristics of a patient sample

Although panic disorder is generally believed to begin in young adulthood, 13 cases of panic disorder with an initial onset after age 60 years have recently been seen at our clinics. Other than the time of life in which the first panic attack occurred, clinical and demographic profiles of these 13 patients were similar to those that have been reported for panic disorder patients whose panic began earlier in life. These findings indicate that panic disorder can affect older adults with no previous history of panic attacks, but further research is needed to determine the clinical and theoretical significance of late-life-onset panic disorder.

Management of death, dying and euthanasia: attitudes and practices of medical practitioners in South Australia

This article presents the first results of a study of the decisions made by health professionals in South Australia concerning the management of death, dying, and euthanasia, and focuses on the findings concerning the attitudes and practices of medical practitioners. Mail-back, self-administered questionnaires were posted in August 1991 to a ten per cent sample of 494 medical practitioners in South Australia randomly selected from the list published by the Medical Board of South Australia. A total response rate of 68 per cent was obtained, 60 per cent of which (298) were usable returns. It was found that forty-seven per cent had received requests from patients to hasten their deaths. Nineteen per cent had taken active steps which had brought about the death of a patient. Sixty-eight per cent thought that guidelines for withholding and withdrawal of treatment should be established. Forty-five per cent were in favour of legalisation of active euthanasia under certain circumstances.

Nurses and the management of death, dying and euthanasia

This article is one of two which report findings of research which examined the attitudes and practices of health professionals in South Australia towards the management of death, dying and euthanasia. The focus in this article is on findings related to nurses. Conducted in August 1991, mail-back, self-administered questionnaires were posted to a sample of 500 nurses on the general nurses register held by the Nurses Board of South Australia. A total response rate of 57.8% was obtained, and 55% (278) were usable returns. The survey found that 47% of the respondents had received requests from patients to hasten their deaths by withdrawing treatment, and 30% had received request from patients for active euthanasia. 'Persistent and irrelievable pain' was the main reason for such requests. The majority either would or did discuss such requests with relatives, other medical practitioners and nursing staff. Nineteen per cent had taken active steps which had brought about the death of a patient. Eighty-two per cent thought that guidelines for withholding and withdrawal of treatment should be established. Sixty per cent were in favour of legalization of active euthanasia under certain circumstances.

Cochlear implants and otitis media: considerations in two cleft palate patients

Cochlear implantation is a safe and effective means of rehabilitating profound sensory deafness. The implications of coincident chronic middle ear disease upon the operative procedure and auditory results have received little attention in the literature. We describe two patients, each with congenital cleft lip and palate and secondary chronic otitis media with effusion, who received multichannel cochlear implants following bacterial meningitis. One patient (a three-year-old girl) was implanted in the standard fashion while the other (a 38-year-old-man) underwent middle ear and mastoid obliteration. Our findings suggest that chronic otitis media should not be a deterrent to cochlear implantation.

Nephrotic-range proteinuria associated with right atrial myxoma

A case of right atrial myxoma presenting with right heart failure and proteinuria is described. Proteinuria was variable and this corresponded with the degree of systemic venous congestion. On one occasion the proteinuria was within the nephrotic range. There was no evidence of intrinsic renal pathology. The right heart failure and proteinuria resolved after tumour removal, suggesting that the etiology of urinary protein loss was a reversible increase in glomerular permeability.

A double-blind comparison of the effects of temazepam and triazolam on residual, daytime performance in elderly insomniacs

Benzodiazepine hypnotic medications are widely prescribed for elderly patients, but there is a paucity of information available concerning the residual cognitive and psychomotor (the morning-after) effects of these drugs. We compared two commonly used hypnotics--temazepam and triazolam--in a double-blind, placebo-controlled, single-dose study with community-dwelling healthy elderly with a DSM-III-R diagnosis of primary insomnia. Forty-five subjects over the age of 65 (mean age 72.23, SD = 4.44) qualified for the study. Subjects were randomly assigned to one of five treatment groups (placebo, triazolam 0.125 mg., triazolam 0.25 mg., temazepam 15 mg., and temazepam 30 mg.). Neuropsychological testing was completed at baseline and 12-14 hours after the dosing. Patients were evaluated with a variety of tests that measured attention, concentration, motor speed, immediate memory, and learning of new information. Separate repeated measured analyses of variance were performed to assess the significant changes among the five treatment groups. We found improved performance or no change in all the measures for all medication groups except for impairment of performance on a serial learning task for both high-dose medication groups. The significance of these results and the need for further research in elderly insomniacs is discussed.

Effectiveness of an intensive speech perception training program for adult cochlear implant recipients

A staggered multiple baseline single-subject experimental design was used to assess the effectiveness of a postimplant intensive aural rehabilitation program. Four adults with an acquired profound hearing loss were provided with a Nucleus 22-channel cochlear implant. The subjects completed a speech perception test protocol once before their cochlear implant operation and at 3-month intervals for a period of 12 months postimplantation. Each subject participated in a 12-week postimplant intensive aural rehabilitation program. A comparison of the prerehabilitation and postrehabilitation results failed to reveal any systematic improvements in performance on the speech perception tests that could be attributed unequivocally to the aural rehabilitation program.

Effect of thiamine on glucose utilization in hepatic cirrhosis

Thiamine, an essential co-enzyme, improves glucose utilization. Thiamine hydrochloride (50 mg per capita per day for 30 days), given to 25 patients with liver cirrhosis who had hyperglycaemia, produced a significant reduction (P less than 0.001) in blood glucose levels. It is therefore suggested that thiamine supplements be given to cirrhotics with hyperglycaemia, to improve glucose utilization.

Hepatotoxicity to different antituberculosis drug combinations

Hepatotoxicity to different combinations of anti-tuberculosis drugs containing, Rifampicin (R), Streptomycin (S), Isoniazid (H), Pyrazinamide (Z) and Myambutol (E) is described in 47 patients who completed 6 to 9 months therapy. Seven cases (15%) showed signs of toxicity and in 4 patients (8.5%) the drugs had to be withdrawn. Two patients developed hepatitis, one with jaundice and the other with fever and deranged liver functions, while others 2 developed severe hypersensitivity reactions. Burning palms, difficulty in micturition, itching and giddiness were complained of by one patient each, which settled in due course without recourse to withdrawal of drugs.

Immunogenicity of yeast-derived hepatitis B vaccine in Pakistani adults

A study of the immunogenicity and safety of 20 micrograms recombinant DNA yeast derived hepatitis B vaccine was conducted in 153 Pakistani adults. All participants were in good physical condition, had negative hepatitis B serological markers (HBsAg, anti-HBs, anti-HBc) and normal ALT. Anti-HBs developed in 33%, 81% and 98% of subjects one month after the first, second and third dose respectively. Minor systemic and local side-effects were observed in 39% of individuals. We conclude that yeast derived hepatitis B vaccine is safe, effective and immunogenic in Pakistani adults.

A double-blind placebo-controlled trial of zopiclone 7.5 mg and temazepam 20 mg in insomnia

Zopiclone, a cyclopyrrolone with hypnotic properties was compared with temazepam and placebo in the treatment of insomnia. After a week's washout period, suitable subjects were allocated at random to zopiclone 7.5 mg or temazepam 20 mg or placebo for 2 weeks. Measurements of psychomotor function using the Leed's psychomotor tester and letter cancellation were carried out on day 0, 7 and 14. Sleep latency, duration of sleep and number of times waking during the night were recorded on a sleep diary filled by the subjects nightly. Forty-four subjects completed the trial, 15 taking zopiclone, 16 taking temazepam and 10 taking placebo. Both zopiclone and temazepam had significant hypnotic properties when compared to placebo. Zopiclone increased total sleep time in both weeks of the trial while temazepam increased sleep time in the first week only. There was no significant deterioration in psychomotor performance at the end of both weeks for zopiclone. Critical flicker fusion was significantly increased in subjects on temazepam. There were no abnormalities for both zopiclone and temazepam subjects in the blood picture, renal profile, liver function, urine and ECG before and after the study. Zopiclone is an effective hypnotic comparable to temazepam.

Intracardiac ectopic thyroid: a case report and review of published cases

A woman with ectopic intracardiac thyroid tissue showing features of a colloid storage goitre presented with ventricular tachycardias and signs of right ventricular outflow obstruction. As the tumour was benign and removed at necropsy, the results of surgery are likely to have been good, but she died from a cardiac arrest before operation.

[Immunosuppressive and virostatic actions of sterones from Petunia hybrida Vilm]

10 Ergostan-3-on derivatives presumably in the majority ergosta-1,4-dien-3-on derivatives could be isolated from Petunia hybrida VILM. Two were identified as the known compounds petuniasterone A and petuniasterone-C-22-O-acetate. The structures of two other compounds named petuniasterone-D-diacetate and 30-hydroxypetuniasterone A could be elucidated. The molecular formulas of the remaining substances were ascertained by mass spectroscopy. The petuniasterones inhibited the proliferation of stimulated human lymphocytes in non-cytotoxic concentrations, possessing therefore possibly immunosuppressive effects. Extracts of the plant and fractions containing a synergistically effective blue fluorescing substance retarded the multiplication speed of influenza viruses; pure petuniasterones were ineffectiv under our conditions in this regard.

Changing patterns of suicide in Australia

This paper examines the suicide trends in Australia from a sociological perspective using a selected number of sociological variables. Our aim is not to minimize the importance of psychogenic factors in suicide but to highlight its sociological aspects. The analysis of suicide trends shows that the overall suicide rate in Australia has remained fairly stable over the past one hundred years. This outward stability, however, camouflages some important internal changes in the suicide trends in Australian society. The paper examines some of these trends and provides a profile of some of the possible sociological factors which appear to have influenced the suicide rates of men and women in Australian society between 1880 and 1985.

Suicide trends in Australia, 1901-1985: an analysis of sex differentials

This paper analyzes trends in the male-female suicide ratio in Australia, using data for the period 1901-1985. The main finding of the paper is that modernization, as measured by an index composed of the female participation rate in the labor force and the urbanization rate, is positively related to the male-female suicide ratio. This is contrary to an earlier finding by Stack and Danigelis (1985), who reported an inverse relationship between these two variables. This finding is shown to be due to the fact that no correction was made for trend. When the data series are corrected for trend, a significant positive relationship is found between modernization and the male-female suicide ratio in Australia. Another finding of the paper is that the female suicide rate in Australia has been falling significantly since the mid-1960s. This is also at variance with Stack and Danigelis's hypothesis that as modernization proceeds, the female suicide rate rises. We discuss reasons for this in the Australian context.

Fracture toughness determination of dental amalgams through microindentation

A microindentation technique was used to study and estimate the fracture toughness of six amalgams. A significant difference is observed between fracture toughness at the bulk and the margin of amalgams. All amalgams show significant differences in fracture toughness as a function of distance from the margin. Microindentation measurement of fracture toughness appears to be an effective method of evaluating the localized brittleness of amalgams.