The Medical journal of Australia
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Twenty-two patients who had received high-dose radiotherapy (50-60 Gy) for non-small-cell lung cancer were retreated with palliative radiotherapy for symptoms that were due to locally recurrent disease. Twelve of the 23 (one patient was retreated twice) repeat courses produced symptomatic benefit. ⋯ There were no other serious complications, even though total tumour doses as high as 120 Gy were achieved. This experience demonstrates that repeated courses of radiotherapy can be given successfully and safely in spite of previous radical dosage.
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Over a six-year period, 12 patients were admitted to a Melbourne teaching hospital with mycobacterial infections of the musculoskeletal system. Four of the infections involved soft tissue and these included three atypical mycobacterial infections. The average age at diagnosis was 60 years. ⋯ The average delay in diagnosis was four months. Treatment involved a combination of appropriate medication and surgical procedures that ranged from diagnostic aspiration to amputation. Mycobacterial infection of the musculoskeletal system, although uncommon in Australia, remains an important problem that requires continued awareness for early diagnosis.
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A woman with autonomic neuropathy after rubella infection is described. She had features of both sympathetic and parasympathetic impairment, the major problems being postural hypotension, abdominal and parotid pain, and fatigue. Autonomic dysfunction persisted 38 months after the rubella infection with minimal response to treatment. The literature relating to autonomic neuropathy is reviewed, and the similarities of this patient's condition to the Guillain-Barré syndrome are discussed.
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A locally-relevant "market basket" has been devised to help to assess the cost of usual food purchases for Aborigines who live in the Kimberley region. The range of foods in the market basket is relatively restricted, especially for fresh vegetables. ⋯ A food-voucher system is proposed as one possible way to help to overcome serious nutritional imbalances for pregnant women and their infants and young children who are especially vulnerable to nutritional deficiencies. This proposal is likely to be politically unpopular, so other ways should be sought to help to improve the health of Aboriginal mothers and their children.
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Although breast cancer is a rare event in pregnancy, the consequences of a delay in its detection and of late-stage disease are tragic for the young woman who presents in her childbearing years. Therefore, all pregnant women with breast problems should undergo a careful assessment. Pregnancy is not a contraindication to orthodox investigations for breast cancer, provided that special care is taken to reduce the risk to the developing fetus. ⋯ The prevention of subsequent pregnancy is not an indication for a prophylactic oophorectomy. A decision for further pregnancies must be made by the patient and the family after sound advice is given as to the prognosis and consideration of the social, economic and spiritual factors. There is no evidence that the termination of a subsequent pregnancy will affect beneficially or adversely the prognosis of a patient with breast cancer.